PATIENT GUIDE

Your hospital bill includes the cost of your room, meals, 24/7 nursing care, laboratory work, tests, medications, therapy and the services of hospital employees. You will receive a separate bill for professional services, including doctors, radiologists, pathologists and others, incurred during your stay.

The hospital is responsible for submitting bills to your insurance company and will do everything possible to expedite your claim. Your policy is a contract between you and your insurance company. You have the final responsibility for payment of your hospital bill.

Houston Methodist Billing Department
PO Box 4315
Houston, TX 77210-4315
832.667.5900 or 877.493.3228

Before you leave, we ask that you pay your co-payment, deductible and/or co-insurance. If Patient Access Services has not cleared you, please check on your account by asking to speak with a financial counselor. You can also stop by the cashier's office before you leave.

Payment can be made by cash, personal check, MasterCard, Visa, American Express, Discover or traveler's checks.

Upon admission or services rendered at any Houston Methodist facility, you or your legal representative must assume some or all of the following responsibilities:

• You or your legal representative can accrue billing from the hospital, doctors and affiliated entities

• If you have surgery, you can accrue billing from the anesthesiologist, surgeon and an independent surgical assistant

• The affiliates listed below are contracted with various insurance plans and may not be covered under your individual plan. Please check with affiliates to determine if they are contracted.

As a service to our customers, Houston Methodist will forward a claim to your commercial insurance carrier based on the information you provide at registration. It is important for you to provide all related information, such as policy number, group number and the correct mailing address for your insurance company. Claims will be filed for inpatient and outpatient hospital charges approximately three to five days after discharge.

Visit houstonmethodist.org/insurancebilling for an updated list of our managed care plans.

If you have questions or need further information while you are still in the hospital, please call patient access services at 281.523.2191.

If you have questions after your discharge, call the Houston Methodist Centralized Business Office at 832.667.5900.

Houston Methodist is an approved Medicare provider. All services billed to Medicare follow federal guidelines and procedures. Medicare has a Coordination of Benefits (COB) clause.

At the time of service, you will be asked to answer questions to help determine the primary insurance carrier paying for your visit. This is referred to as a Medicare Secondary Payer Questionnaire and is required by federal law. Providing accurate information allows us to bill the correct insurance company. Hospital personnel cannot call Medicare on your behalf to correct a COB. The call has to be made by the patient.

Secondary insurance may cover Medicare deductibles and co-insurance. If you do not have a secondary insurance, you will be asked to pay or establish a payment plan. If you are not able to pay, we will help you determine if you qualify for financial assistance.

Coordination of Benefits (COB) is a term used by insurance companies when you have two or more insurance policies.

This usually happens when both spouses are listed on each other's insurance policies, when both parents carry their children on their individual policies, or when there is eligibility under two federal programs.

Most insurance companies have COB rules that determine who pays medical expenses. This prevents duplicate payments. COB priority must be identified when you are admitted to comply with insurance guidelines. Your insurance company may request a completed COB form before paying a claim. Every attempt will be made to notify you if this happens. The hospital cannot provide this information to your insurance company. You must work with your insurance company for the claim to be paid.

Houston Methodist is committed to providing charity care to persons who are uninsured, underinsured, ineligible for a government program, or otherwise not able to pay for emergency and medically needed care based on their individual financial situation.

Patients whose family income is at or below 200 percent of the Federal Poverty Level (FPL) are eligible to receive free services, and patients whose family income is above 200 percent but not more than 1400 percent Of the FPL are eligible to receive services at a discounted amount. This discounted amount is not to exceed the average amount Houston Methodist would get paid by private insurance and Medicare, including any patient payments in the form of deductibles, co-payments and co-insurance.

You will not be required to make advanced payments or payment arrangements for emergency and medically necessary services before you receive care. But if you are required to pay a discounted amount, and you cannot pay it in full after the services are provided, Houston Methodist will attempt to collect it. We will send monthly invoices asking for payment. If you cannot pay the discounted amount in a single payment, we offer interest-free extended payment options. Any discounted amounts remaining unpaid will be turned over to a third-party collection agency for further collection attempts. Third-party collection activity will not include personal liens, legal actions or credit bureau notification.

A free copy of Houston Methodist's financial assistance policy, the financial assistance application and collection policies are available at houstonmethodist.org/billing. You can also find these documents in admitting and registration areas, or you can call the centralized business office to ask for them in various languages.

Houston Methodist's financial assistance team can answer questions and provide information about the financial assistance policy. We can help you with the application process. We are open Monday through Friday, from 7 a.m. to 7 p.m., and on Saturday from 8 a.m. to noon. Completed financial assistance applications and all supporting documents can be faxed or mailed to the centralized business office.

Houston Methodist Centralized Business Office
Attn: Financial Assistance Unit
701 S. Fry Rd.
Katy, TX 77450
832.667.5900 or 877.493.3228
Fax: 832.667.6014

To learn about Houston Methodist's financial assistance program, you can speak with a financial counselor by calling 713.394.6807.

Our financial counselors will ask you or your family member to complete a financial assistance application for uncompensated or discounted hospital care.

Patient access services and patient accounting departments will be responsible for reviewing completed financial assistance application forms and determining eligibility. The eligibility criteria rely on income levels and means testing indexed to the federal poverty guidelines, updated at the beginning of each calendar year and available from the federal government.

Eligible applicants are classified as either financially indigent or medically indigent. The review may be conducted using either the traditional or fast-track method.