Financial Guidelines

Financial Assistance Guidelines

We are committed to providing you with the best possible care. If you have medical insurance, we are anxious to help you receive your maximum allowable benefit. In order to achieve these goals, we need your assistance and your understanding of the payment policy.

We accept cash, checks, Discover, Master Card, Visa and American Express. We will be happy to help you process your insurance claims.

Returned checks will be subject to an additional charge of $30.00.

You must realize however, that:

1. Your insurance is a contract between you, your employer and the insurance company. We are not a party to that contract.
2. Our fees are generally considered to fall within the acceptable range by most companies, and therefore are covered up to the maximum Allowance determined by each carrier.
3. Not all services are a covered benefit in all contracts. Some insurance companies arbitrarily select services they will not cover.

We must emphasize that as your health care provider, our relationship is with you and not your insurance company. While the filing of insurance claims is a courtesy that we extend to our patients, all charges are your responsibility from the date the service is rendered.

Discount guidelines

To allow for discounts to uninsured patients:

• A discount of 20% will be granted to uninsured patients upon request.
• The agreed upon discount will be honored only if full payment is received within 30 days of the first statement date.
• If the payment is not received within the 30 days after the first statement date, no discount will be given.
• Upon receipt of payment, the discount will be applied using the appropriate discount code.
• Documentation of adjustment transaction will be entered on each patient account.

Payment Plan Guidelines

All hospital bills are due in full 30 days after your receive your statement. If an account cannot be paid in full within 30 days, the guarantor must make payment arrangements with the hospital collection clerk. If a payment in full cannot be made within 30 days, the following terms should be met:

1. Balances under $500.00 will be paid in full within six months. Balances $501.00 and greater will be paid in full within twelve months.
2. If the terms listed above cannot be met, acceptable monthly payment arrangements must be agreed upon with the collection clerk at Ellsworth Municipal Hospital. Call 641-648-7018 with questions.