Windom Area Health understands that receiving medical care at a hospital can be a time of anxiety and concern for you and your loved ones. It is our goal to simplify the billing process so that you have one less thing to worry about. Please select one of the brochures listed below for more information on our billing practices.
Depending on your health insurance, this hospital-based clinic may charge a separate facility fee, which may result in a higher out-of-pocket expense. For more information, please contact our Billing Department at 507-831-0616.
Your rights and protections against surprise medical bills
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s co-payments, coinsurance and/or deductible.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a co-payment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as co-payments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
In addition to federal law, Minnesota law provides Minnesota residents with similar rights and protections against surprise medical bills for emergency services and unauthorized provider services provided by out-of-network health care providers.
When balance billing isn’t allowed, you also have the following protections:
- You’re only responsible for paying your share of the cost (like the co-payments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
- Generally, your health plan must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact the Department of Health & Human Services at 1-800-985-3059. Visit www.cms.gov/nosurprises for more information about your rights under federal law. You may also contact the Minnesota Department of Commerce at (651) 539-1600 or 1-800-657-3602 for more information about your rights under Minnesota law.
Many insurance and employer health plans require that certain hospital procedures be pre-certified. Pre-certification requires the plan member to telephone the pre-certification group prior to hospital admission date, condition or illness cause, attending physician and expected length of stay. Emergency admissions generally allow a 24-hour grace period. Most plan identification cards list a toll-free number to call.
Failure to pre-certify may result in substantial reduction in your benefits. Please check your plan card and booklet or contact your claims administrator. Patients will assume financial responsibility if your insurance company is not contacted.
Charges will vary depending on the services provided. You will receive a statement from the billing department advising you of the status of your account. Our charges are for hospital rendered services and these provided by the ER doctors and anesthetists. You will be billed separately by the physicians who administered your care, including any outreach physicians.
As a courtesy to our patients, we will bill your insurance, if all the information provided to us is correct. We will need to review your insurance card(s) at every visit to verify our records. Since your insurance policy is a contract between you and your insurance company, you are ultimately responsible for your bill.
Some insurance companies require authorization for specific procedures performed in an outpatient setting. It is the responsibility of the patient/responsible party to know their insurance policy and call for authorization, or the claim will be processed at a low benefit level.
Windom Area Health will submit your hospital claims to Medicare. Please bring your insurance card(s) to the hospital at every visit so we can verify our records. For your convenience, the appropriate hospital claims will also be sent to your Medicare supplemental insurance.
Medicaid/UCare/Blue Plus requires that you provide the hospital with a current copy of your Medicaid/UCare/Blue Plus Eligibility Card. We will submit claims to Medicaid/UCare/Blue Plus and you will be notified of any non-covered services copays and/or spend down amounts for which you are financially responsible.
Hospital services incurred resulting from a worker's compensation injury must be reported to your employer and your employer must complete a First Report of Injury.
Even though there may be a claim against another person or company, it is your responsibility to notify the appropriate person or business of your possible liability claim with them. You may have given your health insurance information at the time you requested services. However, we cannot file this claim to your health insurance carrier without a payment or denial from the responsible third party or insurance carrier. Medicare recipients must exhaust all other payment options before Medicare will accept responsibility for any bills. Medicare also required providers to notify them of the liability claim, even if no charges are due to Medicare. You are responsible to ensure that Windom Area Health is paid regardless of pending, disputed or litigated claims.
Windom Area Health is proud of its public mission to provide quality care to all who need it, 24-hours a day, 7 days a week, 365 days a year. We provide financial assistance to patients based on their income, assets, and needs.
It is important that you let us know if you will have trouble paying your bill; federal and state laws require all hospitals to seek full payment if what they bill patients. This means we may turn unpaid bills over to a collections agency, which could affect your credit status.
In addition to your hospital bill, you may also receive a separate bill from other providers such as the physician or clinic providing test interpretation (EKG, EEG, Radiology, Pathology). Our financial assistance program relates only to the care provided by and therefore the bill from Windom Area Health.
For more information, please contact our Business Office by calling (507) 831-0616, (507) 427-2700 or 1-800-720-1501. We will treat your questions with confidentiality and courtesy.
Windom Area Health offers a discount to charges for uninsured Minnesota residents with a household income of less than $125,000 per year.
- Cash, checks and money orders are accepted.
- Visa, MasterCard, Discover and American Express are accepted. For your convenience and protection, you may pay by credit card as follows:
- Payment Plans-Our Patient Account Representatives must ensure that financial arrangements are equitable with the hospital's payment policies and we may ask for specific information relative to your current financial situation in order to better determine payment arrangements based on your ability to pay. Windom Area Health is a municipally owned hospital, dependent upon your prompt payment for services rendered.
Prompt Pay Discount
You may be eligible for a prompt pay discount when the balance is paid in full within 30 days of your statement. To receive the Prompt Pay Discount you must contact the Business Office at: 507-831-0616 or 800-720-1501.
We are offering an Eligibility Service that has a no cost for patients, through MedData. Through this program, we can help you understand how your medical bills can be paid by another source, complete any applications, gather necessary paperwork, set up appointments with state caseworkers and make sure that your case is worked aggressively on until it is approved and paid.
It is a way to assist with getting the benefits you need to help pay for your medical bills.
Click below to learn more about the services. Contact the Windom Area Health Billing Department at 507-831-0616 or 1-800-720-1501 for more information.
If Medicare is paying your health care bills and you believe you are being discharged prematurely, you have concerns about your care, or you would like a review of coverage decisions, you may contact:
Minnesota Quality Improvement Organization:
10820 Guilford Road, Suite 202
Annapolis Junction, MD 20701-1105