GENERAL BILLING & FINANCIAL INFORMATION
Our mission at Lake Chelan Health is to provide patient centered, quality healthcare with compassion and respect. Healthcare expenses are often unexpected or may seem overwhelming as a medical condition is discovered and we are here to assist you through understanding your bills, as well as payment options.
In best effort, Lake Chelan Health contracts with as many insurance plans as possible. As a courtesy, we are happy to bill your insurance directly for services provided by Lake Chelan Health. Because each insurance plan has different coverage allowances, benefits, and limitations, payment of services is never guaranteed and are subject to review of the specific plan being billed.
We encourage all patients to contact their plans directly or online to learn more about their specific benefits.
Currently, Lake Chelan Health is contracted with the following plans:
Ambetter (Coordinated Care)
Community Health Plan of Washington (CHPW)
Department of Labor and Industries
Department of Social and Health Services (DSHS)
First Choice Network
Health Alliance – Confluence Health
Health Alliance – Medicare Advantage
Humana Choice Care
Molina – Health Exchange
Premera Blue Cross
Premera Blue Cross – Health Exchange
Regence Blue Shield Northwest Health
United Healthcare – Commercial Plans
United Healthcare Medicare Advantage Plan
United Healthcare Managed Care
United Healthcare – TriCare
Please be advised that this list is subject to change, and although Lake Chelan Health has a contract with an insurance company, this does not guarantee coverage of the services provided.
If you have questions regarding coverage of a service, it is recommended that you contact your insurance company directly.
Understanding your hospital or clinic bill
Although we are one organization, Lake Chelan Health bills separately from Specialty Care. We will submit a claim to your insurance company for services provided. If we are contracted with your insurance company, they will make payment directly to us for your services.
When payment is received, your insurance informs us of what amount is your responsibility based on your plan’s coverage. Any balance remaining after insurance payment and any partial payment made by the patient at the time of service (if any) is due upon receipt of the first statement.
Statements of accounts with balances due are mailed monthly. If you are unable to make payment in full upon receipt of the first statement, we recommend that you contact our Patient Financial Counselor for personal assistance. We have a variety of payment options as well as Financial Assistance. Please note, that partial payments without an agreed payment arrangement on file will not stop an account from escalating to an outside collection agency.
If you have no insurance, or are underinsured, our Financial Assistance and Charity Care programs are available.
Itemized statements are available upon request by contacting our Patient Financial Services department at 509-682-6103.
If you need assistance in understanding your bill, our Patient Billing Specialists are here to help. Patient Financial Services is open Monday-Friday 8:00am – 4:30pm. We’re happy assist you in person, over the phone at 509-682-6103, or by email at firstname.lastname@example.org
Some of the services provided are billed separately and may even be billed by a provider other than Lake Chelan Health. If you receive any of the following services, charges for this will not be included on your hospital bill:
- Primary Care Physician
FINANCIAL ASSISTANCE & CHARITY CARE
Lake Chelan Health offers Financial Assistance to those who are uninsured or underinsured. Discounts are available to those who have received services at either Lake Chelan Health or Specialty Care. Discounts are allowed on a sliding fee schedule to individuals and families that make less than 300% of the Federal Poverty Level.
We have a Patient Financial Counselor who is here to assist you in completing an application for one of our programs and ensuring that your account(s) are placed on hold while applying for one of our programs.
Our Patient Financial Counselor is available Monday – Friday 8:00am –3:30pm. For assistance over the phone or to schedule an appointment, they can be reached at 509-682-6102. You can also contact them by email at email@example.com
Formas En Español
BALANCE & BILLING INFORMATION
With your health plan, you are responsible for certain cost sharing amounts. This includes co-payments, deductible, and/or co-insurance. There may be cases where you are responsible for additional amounts if your insurance is not contracted with Lake Chelan Health. This is often referred to as “balance billing” or “surprise billing”. In many scenarios, however, you are protected by law from receiving a balance bill for your care. To understand your rights and details of your rights as a patient, please click the notice below for additional information.
Balance Billing Protection Act Notice Balance Billing Act Notice
WHERE TO MAKE A PAYMENT
- Online through one of our Patient Portals:
Hospital: Hospital payment portal
Clinic: Clinic payment portal
- If you are having difficulty logging on to one or both of our portals, please contact 509-682-3300 for assistance.
- Over the phone at 509-682-6103 with a Credit Card, we accept Visa, Mastercard and Discover. Please note, we currently do not accept Care Credit.
- In person at our Hospital Patient Financial Services Office
- By mail at:
- 503 E. Highland Ave.
Chelan, WA 98816
- 503 E. Highland Ave.
The Centers for Medicare and Medicaid Services (CMS) as part of the 2019 IPPS Final Rule requires hospitals, including Critical Access Hospitals such as Lake Chelan Hospital make available online a list of their standard hospital charges.
Lake Chelan Health supports the intent of these regulations as a way to inform and educate patients. However, Lake Chelan Health uses a chargemaster system, which is a list of the charges that are the different components to a patient’s care. These are the baseline rates for items and services provided at the hospital. The total charges could vary depending on the scope of the service provided and ordered by their physician.
Many factors may influence the actual cost of an item and/or service, including insurance coverage, rates negotiated with payers, and so on. The cost of treatment might also be impacted by variables involved in a patient’s actual care, such as specific equipment, specific supplies required, the length of time spent in surgery or recovery, additional tests, or any other changes that may have occurred due to unexpected conditions, circumstances, or complications that may arise. Moreover, the foregoing list of charges for services only includes charges from the hospital and does not include charges that would be billed separately such as physician and pathology charges.
We support your concern in learning how much a service and/or procedure may cost and encourage you to reach out to us for an estimate. Our Centralized Scheduling team can prepare a good faith estimate upon request and are happy to discuss our payment options as well. They can be reached at: 509-682-6130.
LINK TO CURRENT PRICE LIST
Click here for hospital price comparisons.
2019 Item Master
The amounts/codes listed on the Item Master are individual items and are not reflective of total procedure cost.
FREQUENTLY ASKED QUESTIONS
Who will bill my insurance?
A Patient Access Representative of Lake Chelan Health will collect your insurance information at the time of service (if applicable). We will then bill your insurance (usually 5-10 days after services were provided) on your behalf. Once the insurance has processed the claim and has determined what the patient is responsible for, Lake Chelan Health will send you a bill. There are times your insurance needs additional information from you, the patient in order to process the claim. If this is the case, a bill will be sent to you for the total amount of the account due to let you know we need your assistance.
Why am I being asked for my insurance information again? My doctor should already have it.
In order to successfully bill your insurance, it is important that we verify your information at each visit. Additionally, physicians are not always employed by the hospital. Physicians keep their own patient information.
I was in the hospital several weeks ago, why haven’t I received a bill?
For patients with health insurance, once your insurance company has been billed and has responded to us, we determine what is patient responsibility, a bill will be sent. Lake Chelan Health mails statements on a monthly basis. Please be advised that it can take a minimum of 45 business days on average for an insurance company to process your claim.
Why did my statement have an “adjustment” amount?
This adjustment amount is referring to the amount of the bill that Lake Chelan Health has agreed not to charge you in agreement with your insurance company. Insurance companies, if contracted with the hospital, pay the hospital at a discount, or “negotiated” contract rate. When the insurance company pays their portion, the discounted amount (adjustment) is taken off to show the true amount due from the patient (co-payment, co-insurance, and/or deductible). For example, a hospital may charge $10,000 for a surgery that your insurance has only agreed to pay $2,500. Of that, the patient would be responsible for paying $500 if their co-insurance was 20%. Therefore, the insurance would pay $2,000, the patient would pay $500, and $7,500 would be the contract adjustment the hospital would put onto the patient account.
I have coverage under my own insurance through my employer, as well as my husband’s. Since the deductible is less with his insurance, can I use his insurance instead of mine?
Unfortunately, no. Under a provision called “Coordination of Benefits”, the hospital is required to bill the insurance that would be considered primary for you, which would be your own. Your husband’s insurance would be secondary. Any health insurance which you are the primary holder, must be billed before any other insurance. If you have dependents with more than one insurance, such as children who are covered by both parents. The “Birthday Rule” would apply. The primary insurance would be determined by whichever parent’s birthday came first by month (not year of birth).
What if my service is related to an accident or injury, such as an automobile accident?
If you seek treatment for accident related illness or injury, you should let the Patient Access Staff know. If there is other insurance involved that might be responsible for payment, we can bill them on your behalf. Note, that if services are related to an accident or injury where someone else may be liable, your medical insurance may not make payment. It is best to disclose this information as soon as possible to resolve any bills associated with care. You will be responsible for any amount not paid by the insurance.
What if I am in the middle of a lawsuit?
A lawsuit is an action taken between you and another party which does not involve us. You are responsible for your account, not the third party. We are unable to wait for settlement or judgement to be paid. If unable to make payment in full, we suggest setting up payment arrangements on your account.
Who is responsible for payment and follow-up with the insurance company?
If you are 18 or over, you are legally responsible for your own account, regardless of who carries your insurance, if you are claimed as a dependent on another person’s taxes, or who you live with. If the patient is under the age of 18, BOTH parents, despite divorce or legal separation, or the legal guardian are responsible for payments.
We encourage you to know the specifics of your insurance plan, its exclusions and limitations of benefits, co-pays, co-insurance, and deductible amounts, second opinions, pre-authorized services, preferred providers, covered and non-covered services. Lake Chelan Health does request pre-authorization from your insurer for your hospital and/or surgical visit. This DOES not guarantee payment. Payment will be made according to your contract with your insurance.
Lake Chelan Health can provide you with the medical information needed to dispute and/or appeal if you disagree with how your insurance processed your claim for services provided.
Can I find out how much I will need to pay?
A representative from Patent Access Department or Centralized Scheduling may provide you with a good faith estimate. Some services are difficult for us to estimate, unless we know exactly what your physician plans to order. If you have a signed physicians order, this is best. The estimate provided with be a “best estimate” based on the information regarding your procedure provided by you, your physician and/or healthcare provider and the billing codes. If you are insured, it will also take into consideration your how your insurance covers that service. Estimates can be provided prior to, or at the time of service for most services. Some services such as Emergency Room, Observation, and/or Inpatient services are difficult to estimate due to the circumstantial nature of the services being provided. However, we will inform you of your insurance coverage in these cases.
Do you have someone there to help me apply for insurance?
Yes, we do! Our Patient Financial Counselor is not only here to assist those in making payment arrangements, apply for Financial Assistance, they are also a certified Navigator for the state of Washington. You can schedule an appointment with them by calling 509-682-6102 or by email at firstname.lastname@example.org
Lake Chelan Health