Billing & Insurance Frequently Asked Questions

Why am I required to show my insurance card at every visit?
Insurance plan benefits, eligibility and billing addresses change frequently, so some carriers require us to verify your insurance each time you visit. Checking your card only takes a minute, and it can ensure accurate and timely billing.

What if I don’t have insurance?
MyMichigan provides financial aid to patients based on their income, assets, and needs. In addition, we may be able to help you get free or low-cost health insurance or work with you to arrange a manageable payment plan. If you believe you will have trouble paying your bill, please contact our financial counseling office at (989) 488-5815, or toll free at (844) 832-1956.

What does my insurance cover?
Your best source of information about your specific coverage is your insurance company or your employer if you are covered through work. Although you may have health insurance, you have final responsibility for your bills.

When do I need to get authorization from my health plan provider prior to receiving services?
Depending on your insurance plan, you may be required to get authorization from your insurance company or your primary care physician before receiving services such as emergency room care, physical therapy, referrals to specialists, hospital admissions, urgent care or medical equipment and supplies. If you do not obtain proper authorization, all charges could become your responsibility. Check with your health insurance provider to find out the requirements of your particular plan.

What is an advanced beneficiary notice?
An advanced beneficiary notice (ABN) is a form that lets you know that Medicare may refuse to pay for a procedure or test - even though your health care provider feels it is necessary in order to offer you the best care. This only relates to patients covered by Medicare.

The ABN helps you make an informed decision about whether to obtain the service and pay for it yourself or choose not to receive the service. For answers to more questions about ABNs, please view our brochure, "Medicare Requires Advanced Beneficiary Notice."

Why do I sometimes see multiple line items on my bill after a regular doctor visit? And why does my insurance company label some of the charges as "preventive" and expect me to pay this portion?
During the course of your preventive health exam, your provider may also discover, investigate, and/or treat any illnesses or other irregular conditions you might be experiencing. Correct coding guidelines require providers to code and charge for each service separately. However, insurance carriers differ in their interpretation of this, and many do not provide a benefit for both preventive care and illness care when provided during the same visit.

Most insurance companies will only provide a benefit for one annual physical per enrollee per year, and some do not provide any benefit for preventive care. To avoid unexpected out-of-pocket medical expenses, we encourage you to verify your insurance benefits before scheduling any preventive care services.

Why are you not billing my health insurance for this auto accident?
In most cases, health insurances have an exclusion not to pay primary on auto accident claims. You should contact your insurance to see if this exclusion applies to your coverage.

How long do I have to pay off my balance?
Your bill is due upon receipt. If you are not able to pay in full, please contact our Customer Service department to make arrangements by telephone, or you may wish to come in personally and see a Financial Counselor. We have different options for payments depending on each individual circumstance.

If you’ve recently changed providers or insurance plans, you may discover that your provider is no longer “in network” for your particular Medicare or Medicaid plan. These FAQs will help explain your options.

1. Can I still receive care from MyMichigan Health or my MyMichigan Health Network provider with an out-of-network health plan? Yes, however all non-emergent services may require prior authorization from your health plan. To avoid any potential delays or difficulty in accessing care, please check with your insurance plan as early as possible to verify any out-of-pocket impact for receiving out-of-network care.
2. What are my options if I want to stay with MyMichigan Health and my current providers? You may have the option to switch to a participating health plan at certain times of year or by filing a special disenrollment form (see questions 8-12.). If you switch to an in-network/participating plan you will need to designate/select your current PCP to be assigned to you. If you decide to continue with your current out-of-network plan, this may impact your costs and your ability to obtain prior authorization for care. (See questions 4 and 5.) To find a list of insurance plans that MyMichigan’s hospitals participate in, visit www.mymichigan.org/insurance. To find out which insurance plans your MyMichigan Health provider participates in, visit www.mymichigan.org/doctors and search for your provider’s profile page.
3. Will MyMichigan Health accept my out-of-network insurance when I receive care in the emergency department? Yes, you are covered under Emergency Medical Treatment and Active Labor Act (EMTALA) legislation dictated by the Federal Government.
4. How do I obtain prior authorization from my health plan for a scheduled service? MyMichigan Health will attempt to secure an authorization for you to continue your care. If prior authorization is denied by my health plan, what happens?
   • Medicaid: If an authorization is denied as out-of-network from your health plan, and you would still like to move forward with your care at MyMichigan Health, we will provide you a cost estimate. You will need to sign a No Surprise Billing Consent Form and submit payment 3 days prior to your procedure. MyMichigan Health is not able to bill your Medicaid insurance for services.
   • Medicare Advantage: If an authorization is denied as out-of-network from your health plan, and you would still like to move forward with your care at MyMichigan Health, we will provide you a cost estimate. You will need to sign a No Surprise Billing Consent Form and submit payment 3 days prior to your procedure. MyMichigan Health will courtesy bill your Medicare Advantage insurance for services.
5. If I decide to continue with a MyMichigan Health provider and I have an out-of-network/non-participating plan, how will that impact my out-of-pocket costs? For regulatory reasons, you will be required to sign a No-Surprise Billing consent form, acknowledging that you are out of network, authorizing us to bill your insurance on your behalf, and assuming responsibility for any costs that are not covered by your plan, up to the amount allowed by Medicare or Medicaid. We can provide an estimate of your out of pocket costs before you sign the form. However, since coverage details vary by plan, you should always check with your insurance company to confirm your specific coverage details. In any event, the maximum amount you’ll be responsible for is the difference between what your insurance pays and the amount allowed by Medicare or Medicaid.
6. What if I’m not comfortable signing the No-Surprise Billing Consent Form?It’s to your benefit to sign the form, since that enables us to bill your insurance on your behalf. However, if you’re not comfortable signing the form, we can still provide the service and bill you directly, and then you would need to work with your insurance company to get reimbursed.
7. I received a letter from my health plan assigning me to a new Primary Care Provider. Can I stay with MyMichigan Health and my current MyMichigan providers?
   • If you elect a participating plan with MyMichigan Health, you will need to designate/select your current Primary Care Provider (PCP) to be assigned to you with your new plan. To find a list of insurance plans that MyMichigan’s hospitals participate in, visit www.mymichigan.org/insurance.
   • To find out which insurances your MyMichigan Health provider participates with, please visit www.mymichigan.org/doctors/
8. When can I change to an in-network insurance plan?There are specific times when you can join a Medicare Advantage or Medicare drug plan, or make changes to your existing Medicare coverage. You can find these dates and circumstances on Medicare.gov. We recommend that you work closely with your employer, insurance carrier or insurance broker to fully understand your options so you can make an informed decision. You can also contact 1--800-MEDICARE for more information.
   • Medicaid: Open Enrollment is based on the last digit of your Medicaid ID number (examples: 1=January, 0=October). There are no patients with a November or December enrollment anniversary.
   • Medicare: October 15–December 7
   • Medicare/Dual Eligible: October 15–December 7
9. How long will it take to process the change and what do I do in the meantime? Please contact your health plan for additional information.
10. Do you know my assigned month for changing my Medicaid coverage? Your Open Enrollment month is based on the last digit of your case number (examples: 9=September, 0=October). You will receive a letter the month prior to your Open Enrollment month informing you when you can change your health plan. No case numbers are assigned for November or December.
11. I was dis-enrolled from Medicaid and I want insurance through the Marketplace, who should I contact? If you were dis-enrolled because you did not respond to the request for financial information, please contact the Healthcare Marketplace: www.healthcare.gov or (800) 318-2596. If you were dis-enrolled because you no longer qualify for Medicaid, please contact MyMichigan Financial Counselors. *See MyMichigan Health Contacts on back page.
12. How do I dis-enroll with my Medicaid health plan outside of my open enrollment period? There is a special dis-enrollment form that the patient can request from MDHHS. The dis-enrollment reason is required when you are changing to a different plan. Choose the reason that best fits why you are changing your plan. (example: provider not participating with health plan, lack access to services in my area, etc.)
13. Will I be able to change my Medicaid plan if automatically assigned a plan at initial enrollment? Yes, you can change your plan within the first 90 days of initial enrollment. After 90 days, you are committed to your plan until open enrollment. You may also request a special dis-enrollment form from the state if you are trying to change plans outside of this timeframe.

Definitions

• In-Network Provider/Hospital - A provider or hospital who has a contract with your health insurer or plan who has agreed to provide services to members of a plan. Also called “preferred provider” or “participating provider.”
• Out-of-Network/Non-Participating - We do not have a signed contract that allows us to see patients easily for their healthcare needs. An authorization is required from your health plan prior to being seen and for any test or procedure.
• Balance Bill - Patients being seen for non-emergent services may be responsible for their hospital bill. Contact MyMichigan Health Patient Billing at (844) 832-1956 with inquiries.
• Signing a No Surprise Billing Consent Form - The No Surprise Billing Consent Form is provided when your plan is not contracted with MyMichigan Health. • Medicaid: Insurance is not billed; patient is held financially responsible. • Medicare Advantage: Insurance is billed, patient is held financially responsible for what is not paid by insurance.
• Dual Special Needs Population (DSNP) - A population of patients that qualify for Medicare primary and Medicaid secondary.

Medicaid, Medicare and Dual Eligible Contacts Product Who to Contact?

• Medicaid
  1. MI Enrolls: (888) 367-6557, option #3
  2. Beneficiary Help Line: (800) 642-3195
  3. MDHHS Case Worker

• Medicare Advantage
  1. 1-800-Medicare: (800) 633-4227
  2. Medicare.gov

• Dual Eligible
  1. MI Enrolls: (888) 367-6557, option #3 (Medicare/Medicaid)
  2. Beneficiary Help Line: (800) 642-3195 MI Health Link
  3. MDHHS Case Worker

MyMichigan Health Contacts

If you have questions about Medicaid or Medicare, please contact MyMichigan Health’s Patient Accounting Financial Counselors. Monday – Friday 8 a.m. – 4:30 p.m. (844) 832-1956 or patient-financial-services@mymichigan.org. Financial Counselors can assist with:

• Applying for Medicaid
• Setting up payment arrangements
• Applying for Medicare
• Providing price estimates
• Helping with financial assistance
• Helping contact DHS case worker

Who can authorize medical treatment for my minor child if I am not available?
This form, Temporary Delegation of Guardian/Parental Rights and Limited Power of Attorney for Consent to Provide Treatment , may be used for a parent/guardian to grant written permission if your child or ward needs non-emergency medical care, whether in a doctor’s office or in the hospital.

My 18-year old child is covered on my insurance plan, and I am paying the bills. Why won't you tell me the details behind these bills when I call?
By law, we must protect the confidentiality of health information for anyone 18 or older. If you need more details about your child's diagnosis or treatment in order to understand a bill you have received, you will need to ask your child to contact us for this information.

What does it mean when my statement says, "Please contact our office?"
This means we are requesting additional information in order to properly bill your claim to your insurance company. Please call the billing department at (989) 633-1459.

What does it mean when my statement says, "Submit to Wright & Fillippis?"
Per your Blue Cross/Blue Shield (BCBS) contract, your in-network provider is Wright & Fillippis. Please contact BCBS for further information.

What does it mean when my statement says, "Submit to Northwood/NPN?"
Per your Blue Cross/Blue Shield (BCBS) contract, your in-network provider is Northwood. Please contact BCBS for further information.

What insurances will you bill?
In general, we will submit a claim to all insurances on your behalf. We cannot guarantee payment by any of your insurance companies and any balance that is remaining after your insurance pays will be your responsibility.

If I am treated in the hospital, what other bills will I receive?
In addition to your bill from the hospital, you may receive bills from other physicians who may have provided services to you. For instance, you may receive bills from consulting physicians, radiologists, anesthesiologists and other specialists. Please contact their office directly if you have questions concerning their bills.

Why was my account sent to Computer Credit, Inc. when I have been making payments?
This may happen when you do not pay your bill in full, but fail to contact us. We have an automated billing system; therefore it is very important that you contact Customer Service if you are unable to pay in full when you receive your first statement.

Why do I have more than one patient number when I am only one patient?
Unfortunately, our system is set up to give a new patient number for each encounter. If you are paying your bills and have more than one you may just write one check, but include each account number for which you are paying.

What qualification do I have to meet to qualify for Medicare benefits?
According the Medicare guidelines, residents must have first had a three-day qualifying acute hospital stay before Medicare will cover their SNF stay. Residents must be admitted to a SNF within 30 days of the three-day qualifying stay. The resident must require skilled nursing services on a daily basis, or skilled rehabilitation services five days a week. These services must be performed by or under the general supervision of a professional staff and, be provided on an inpatient basis in a skilled nursing facility.

How many Medicare coverage days can a resident receive?
Part A will cover up to 100 days of a resident’s stay in a SNF. According to guidelines, during the first 20 days of the 100 day period, Medicare will cover 100% of costs. After this, coinsurance-either private insurance or Medicaid, depending on the state-will become the secondary payer. Every year, CMS sets new rates for coinsurance. This year, Medicare has set a coinsurance charge of $105.00 per day for the days 21 through 100 of the resident’s stay.

What does a resident do when Medicare benefits exhaust and/or are terminated and would like to become a permanent placement?
Arrangements would be made with the Business Office (billing) as to how the resident’s continuing stay would be covered. A resident would become either a Private Pay or Medicaid resident, whichever they qualify for. If a resident carries a Long Term Care Insurance that covers basis and/or custodial care, the resident would be a Private Pay resident and would be responsible for submitting the monthly claim to his/her Insurance carrier for reimbursement.

How does a resident go about applying for Medicaid?
Medicaid information and applications may be picked up at the Business Office. They will assist to the best of their ability in answering any questions or filling out the application.

Who pays for Leave of Absence (therapeutic overnight) and Bed-Hold (hospitalization) days?
If the resident were a Private Pay resident they would be responsible for payment any Leave of Absence and Bed-Hold days. Medicaid will pay for 18 Therapeutic Leave days in a 365-day period and up to 10 Bed-Hold days for each hospitalization as long as the patient pay amount as assigned by the State is met.