Billing & Insurance Information
No Pascack Valley Medical Group patient is denied care based on a third-party determination. In conjunction with your physician, our case manager, social worker and financial counselor will work closely with you and your family. They will help identify an alternate care setting, payment arrangements, help from charitable agencies and organizations, or in some cases, reductions in your bill.
About your bill
Most insurance carriers take 30 to 45 days to process a claim, after which the hospital will seek your assistance in getting paid. If a claim is not paid within 75 days, the hospital will consider the bill a patient’s responsibility.
You should verify the accuracy of any bill when you receive it, and compare statements from the hospital and insurance carrier to ensure that they are in agreement. Also, follow up with the insurance carrier or hospital if you have not received a bill or notice of payment within 45 days of service. Insurance carriers frequently deny claim submissions after 60 days, and payment for late submissions may be considered your responsibility. You should assist the hospital in appealing to the insurance carrier for any services that are not paid. Your prompt payment of deductibles or coinsurance is appreciated.
Insurance Information
OUT OF NETWORK
Hackensack Meridian Health Pascack Valley Medical Group is committed to providing information our patients need to protect them from receiving a surprise medical bill.
We have worked throughout Pascack Valley Medical Group to try to make sure we are meeting the requirements of New Jersey’s new law.
While we have taken steps to fully comply with our requirements on behalf of patients, it is very important that healthcare consumers also consult their own health insurance plan. Only your health insurance plan can provide detailed information about your coverage and potential obligations for certain out-of-pocket costs. The contact information is on your insurance card.
In accordance with the new law, we have listed below the insurance plans whose networks we participate in. You can contact the physician directly to ask about their network status with your particular health insurance plan.
- Aetna (All products including Medicare Advantage)
- Aetna Better Health (Medical plan)
- Americhoice (Medicaid plan)
- Amerigroup (Medicaid plan and Medicare Plan)
- AmeriHealth (All products)
- CHN
- CIGNA
- Clover Health/Carepoint
- Devon Health Services
- Empire Health Plan
- First Managed Care Option
- Horizon BCBS of New Jersey (All products, including Omnia Tier 1)
- Horizon NJ Health
- Brighton Health Plan Solutions fka MagnaCare (Create Flex and Select Products)
- PHCS/Multiplan
- Qualcare
- TRICARE/Champus - Humana Military
- UnitedHealthcare/ Oxford Health Plan
- United Payers and United Providers
- UMR
- Wellcare Medicare
EXCHANGE PLANS
- AmeriHealth (AmeriHealth Advantage Plan)
- OMNIA (Horizon)
- Oscar
*Please note: this list is subject to change. This list should not replace the confirmation of a patient’s eligibility and coverage with a specific health plan.
While we have tried to make our network status clear to all healthcare consumers, it is important to note that the state’s new out-of-network law does not apply to health insurance plans issued outside of New Jersey. Even if you live in New Jersey, if your employer is located in another state, it is possible that your plan is not covered by the law. Also, the new law is optional for self-funded plans. Self-funded plans are when the employer assumes the responsibility to cover all of the expenses of the plan. Self-funded plans are only required to follow federal requirements, not state laws. A self-funded plan may opt in and elect to be subject to New Jersey’s out-of-network law, but it is not required to do so. It is important that you ask your employer or health insurance carrier whether the new law applies to your plan.
All stakeholders – insurance plans, healthcare providers, state policymakers and regulators – must try to make this complex law understandable to healthcare consumers, particularly those who may not realize that their plan is not covered by these new protections.
If you have any additional questions please do not hesitate to call (844) 831-0709.
Understanding Your Bill
Reducing the Confusion
You will probably receive more than one bill for services rendered by the hospital. Usually, one bill is sent for the use of hospital equipment, supplies, your room and board, and the time the nurses and other staff spend meeting your health care needs. The hospital bill does not include fees of any treating physicians.
You may receive separate bills from your personal physician, and any other physicians involved in interpreting tests or performing other services. For example, a cardiologist, pathologist, radiologist or anesthesiologist will each send a separate bill for his/her services. The physicians providing professional services in Anesthesia, Radiology, Pathology and the Emergency Department are not employees of Pascack Valley Medical Group. They are independent contractors. You will receive a separate bill from each of these independent contractor groups if these services are utilized during your hospitalization.
If you are covered by managed care, an HMO, or other insurance, the hospital will automatically bill the insurance company (or companies) on your behalf. This can only be accomplished if the hospital is provided with correct insurance information.
In most cases you are responsible for any charges not covered or approved by your medical insurance company or managed care organization. You must pay your bill promptly or notify the hospital if you cannot. In the case that you won’t be paying your own bill, you must tell us who will.
How charges are determined
Hospital charges are determined by Medicare or Medicaid – or are based on the hospital’s charges or negotiated rates with insurance companies. These parties do not pay for a hospital stay that is not medically necessary. Upon determination that hospitalization is no longer medically necessary, you and your physician will be notified as required by state regulation.
Calculating the cost of hospital care
If you request an itemized bill, the hospital will provide one – and will explain any questions you may have. You have a right to appeal any charges. We can also assist you in obtaining public assistance and the private health care benefits to which you may be entitled.