Insurance Coverage

Understanding Insurance Coverage

If you have health insurance, we will bill your insurance company on behalf of you. At times The Richland Hospital, Inc or your insurer may need additional information to process your claims. Please be sure to respond promptly to any requests for more information.

You may still owe a balance after your insurance plan pays your claim. Your insurance plan may require multiple deductibles, copays and/or coinsurance. Coverage will depend on the type of plan you have chosen.

If your insurance provider does not make payment timely or does not respond to our attempts to resolve payment matters, we will send you a bill. Be sure you know your health insurance policy and all pre-certification and pre-authorization requirements. If your health insurance denies your claim, you will be responsible for contacting them for resolution or you may be responsible for the charges.

Network Status

The Richland Hospital, Inc. participates in a variety of health plans. You can learn the details of your policy by visiting your insurance company’s website or contacting its customer / member services department. The back of your insurance card should include the phone numbers and website addresses you’ll need.

Questions to Ask Your Insurer

  • Is the Richland Hospital, Inc. In-Network for my plan? If not, how will this affect payment for the services I would receive?
  • Is my hospital service covered completely? If not, how much will I be expected to pay?
  • If I need tests, will they be covered completely? If not, how much will I be expected to pay?
  • If I need a procedure, including surgery, how much will my insurance cover? How much will I be expected to pay?
  • Will I need authorization before my healthcare visit?

In-Network Status

The Richland Hospital, Inc. is in network with many insurance plans. The Richland Hospital, Inc. is continuously working with various plans to become part of their Network. Please contact your plan as noted above to determine your network status.

Out-Of-Network Status

If your health insurance plan is out-of-network, you may still be seen by a The Richland Hospital, Inc. provider; however, you may experience higher out of pocket costs than if you are seen by a Network Provider or your services may not be covered. Please contact your plan as noted above to determine your network status.

Insurance Terminology

Coinsurance: a term in a policy, where the insured person and the insurer share the covered charges under a policy in a stated ratio. For example: A certain medical procedure is covered 80 percent by the insurance company and 20 percent by the insured.

Copay: a small fixed amount required by a health insurance company to be paid by the insured for each outpatient visit or drug prescription. For example: Your doctor prescribed a medication that costs $50. The copay assigned by your health insurance company is $20. You will pay $20 and the insurer will pay the remaining $30 for the $50 prescription. A generic version may save you money, as copays for generic medication can be much lower than brand names.

Deductible: the amount for which the insured is responsible for on each loss, injury, etc, until satisfied, before an insurance company will make payment: For example: The deductible on his medical coverage has been raised from $2000 to $5000 per family per year.

Premium: The amount paid by a policyholder to keep an insurance policy in force, usually monthly. Sometimes the premium is paid for by the insured’s employer or a portion is paid by the employer and a portion is paid by the insured.

Policy: The legal document issued by an insurance company to a policyholder, which outlines the conditions and terms of the insurance.

Insurance Disclaimer

Insurance companies, carriers and plans that are accepted by Black River Memorial Hospital are listed here for your convenience. Insurance plans, coverage and contracts change frequently and, although we strive to keep our website up to date, the most recent changes may not be reflected here. It is your responsibility to verify with your insurance carrier that your plan will cover medical services provided by Black River Memorial Hospital providers.

Healthcare Pricing Information

HFMA has developed a guide to help consumers understand where to get answers to their questions about healthcare prices, compare prices among providers, and manage their out-of-pocket costs. Below are links to the guides:

Wisconsin Hospital Association’s Price Point

The PricePoint web site allows healthcare consumers to receive basic, facility-specific information about healthcare services and charges. Consumers can query information for Inpatient services, Outpatient Surgeries, Emergency Department and Urgent Care visits, Observation services, and ancillary services like radiology and therapies. Below is a link to PricePoint.

Wisconsin PricePoint. Find prices for services, and compare with other hospitals.

For additional pricing information, please contact the Patient Accounting Department of The Richland Hospital at (608) 647-6321.

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