What if services are not covered by my health plan?
Saint Joseph Mercy Health System will bill your health plan. If your plan determines that services provided are not a covered benefit, you will be billed. The hospital will expect payment in full upon receipt of your statement. Medicare and Medicaid do not cover certain services. For services that are not covered, the hospital will expect you to pay. Patients who are covered by Medicare will receive an Explanation of Medicare Benefits (EOMB), which will identify the services not paid by Medicare. An example of a service that would not be paid by Medicare is self-administered drugs. One example of a service that would not be paid by Medicaid is physical therapy.
Patients who have Medicare may be asked to sign an Advanced Beneficiary Notification. By signing this document, you acknowledge that Medicare will not pay for the services. Medicare patients will be billed directly for non-covered services. Some of the services ordered through outpatient laboratory testing are not covered by Medicare and require the patient's signature prior to administering the test.
If you are unsure whether services will be covered, we recommend that you contact your insurance plan for more information.
