Riley Hospital for Children at IU Health flu-related visitor restrictions have been lifted. However, because babies, especially those who are ill or premature, are at higher risk of serious complications if they get the flu, visitation restrictions are still in place for all Neonatal Intensive Care Units (NICUs) until further notice.
Below you will find commonly asked questions regarding billing and insurance. Before calling to ask your question, please review this information to see if an answer is provided.
Before initiating a new payment, gather the following information:
The routing number is a nine-digit number that identifies the institution with which you have the account. To find it, look for the numbers shown at the bottom of your check or on your savings deposit slip.
Contact our Customer Service department for all questions about your account balance.
Please allow 2-3 business days for your payment to be posted to your account.
We make withdrawals authorized by you from the checking or savings account that you designate as the payment account. As with any payment account, you must provide sufficient funds to cover all payments. Since we have no knowledge of your account balance at any time, we cannot notify you if your payment account has insufficient funds. There will be additional charges for payments attempted against accounts with insufficient funds.
We ONLY have access to your account to make payments that you have authorized. We never access your payment account(s) without your authorization and, as noted above, we do not have information about your account balance.
We are committed to protecting your personal information. In addition, whenever you are viewing or paying bills, you are using a secure connection that fully protects your information. Data you provide cannot be viewed by anyone else on the Web, and we do not share your information with anyone else. Security is maintained by industry-standard SSL (secure socket layer) encryption and decryption technology. The SSL protocol is used to ensure that your information is sent directly to us, and that only we can decode it.
While you are using our service, we need to store some information on your computer's hard drive in the form of a cookie. (A cookie is a small file that a website puts on your hard drive so that it can retain information for later use.) For this reason, the cookie functionality must be enabled in your browser in order to use the digital billing system. However, the cookie will never read information from your hard drive or copy information about other sites that you visit.
With exceptions, we support Netscape version 6 or higher, and Internet Explorer (IE) version 4 or higher. These versions support "strong" encryption, which ensures that your information is safe. (Encryption allows us to encode your information so that no one else on the Internet can read it.)
Exceptions, as noted above, include:
Consolidated Patient Statements (CPS) are based on the principle of one patient, one guarantor. These statements show the amount owed for both physician and hospital bills.
If all your physician and hospital bills have the same guarantor, you will receive one statement. If you have different guarantors on any of your physician and/or hospital bills, you will receive one statement per guarantor.
To help with any questions you may have about the new CPS bill, we have put together a sample statement with explanations and definitions for you. If you are unable to find the answer to your question on this, please contact our Customer Service department during normal business hours.
We receive all of your personal and insurance information from the department with whom you first registered. If there is an error, please provide us with the correct information and we will follow up with the appropriate department to ensure that this does not happen again.
Our charge amounts are a product of our costs and the Indianapolis market. Each year, we get the publicly available MEDPAR (Medicare Provider Analysis and Review) data to ensure that what we charge is in line with what others are charging for the same services. We also need to ensure that we cover both direct (nursing, supplies, etc.) and indirect (accounting, depreciation, etc.) costs.
An EOB, or Explanation of Benefits, is a statement sent that provides necessary information about claim payment and patient responsibility amounts.
Some of the information you may see on an EOB includes:
No. An EOB is simply an explanation of your insurance benefits. If your EOB shows a deductible, co-insurance and/or co-payment amount on it, you will receive a bill from Riley at IU Health once we’ve received and posted your insurance company’s payment.
Your physician has changed from physician-based billing to provider-based billing. Provider-based billing, also known as hospital-based outpatient billing, refers to the billing process for services rendered in a hospital outpatient clinic.
Previously, your physician was doing the billing for all of the components of your visit, which included the physician’s services, the building, nurses, supplies, equipment, utilities, legal, and accounting. Now, by implementing provider-based billing, the physician is only billing for the physician services. The hospital now bills for all other components of your visit.
Riley at IU Health and our partnering physicians chose to do provider-based billing because it ensures more appropriate payments. Also, provider-based billing is the national model of practice for large, integrated delivery systems involved in patient care and is approved by Medicare. By choosing a physician from Riley at IU Health, you have elected to be treated by a provider that can offer all of the amenities that come with a large, integrated delivery system.
Yes, our Patient Financial Service Representatives are here to assist you from 8 am – 4 pm EST, Monday – Friday, excluding all major holidays. You can find our office at 250 N. Shadeland Avenue, Indianapolis, IN 46219.
Yes. The payment will post to the oldest date of service with an outstanding balance.
On February 1, 2011, Riley at IU Health implemented a new Consolidated Patient Statement (CPS) which allows us to have one bill per patient per guarantor.
All services incurred on or after February 1, 2011, will be on one statement. Both physician and hospital bills will be on the same statement. Part of this implementation included adding a new "Minimum Due" payment option. This option allows you to pay a pre-calculated minimum amount each month without any additional costs to you and without having to contact our Customer Service department.
All services provided prior to February 1, 2011, will continue to be billed separately. For these, you may make payment arrangements to pay the balance of your invoice(s) in 12 equal monthly payments without any additional cost to you. A minimum monthly payment is $75. To set up payment arrangements, please contact our Customer Service department during normal business hours.
We received an overpayment on your invoice. Either you have paid too much on your invoice and/or your insurance paid at a later date and covered some of what you had already paid.
If you feel that you have received this refund in error, please contact our Customer Service department during normal business hours.
Some insurances pay using the DRG (Diagnosis-Related Group). A DRG payment is one payment by your insurance company for your entire stay. This payment is based on your diagnosis rather than on each individual charge, regardless of the length of stay or what the total charges were. It doesn't matter if the patient stay was 5 days or 30 days, or if the charges were $50,000 or $500,000. The hospital will get paid exactly the same amount.
Under your coverage plan, you are still responsible for a co-pay when your insurance pays based on DRG.
Please contact your insurance company or review your benefits booklet for more information on your insurance coverage if your personal liability is larger than you expected.
Additional Information: When Medicare was established in 1966, the regulations specified that Medicare would not pay charges, but would pay hospitals the cost of services provided. Charges became less important, and attention was focused on the best way to incur and report costs. Insurers and patients still paid charges however, so that in order to make any return on investment (profit) hospitals increased charges above cost. With the advent of Managed Care in the 1980s, insurers also obtained discounts from charges. Medicare changed to the Diagnosis Related Group (DRG) methodology in 1982. This system pays hospitals an amount based on the diagnosis of the patient.
We can assist you in several ways. If you do not qualify for any type of government programs, we can review your financial status to see if you qualify for our Financial Assistance Program.
We also provide a financial adjustment to any uninsured patient who obtains medically-necessary or emergency services from Riley at IU Health.
Read your insurance plan booklet to be sure you have followed all the guidelines for referrals and authorizations, or call your insurance company for assistance. Failure to follow your plan requirements may result in greater out-of-pocket expenses for you. Your primary care physician (PCP) plays a very important role in this process. If your PCP gives you a verbal authorization number, please provide us with this information at registration.
You will need to provide us with complete primary and secondary insurance information. As a courtesy to our patients, Riley at IU Health submits bills to your insurance company and will do everything possible to advance your claim. However, it may become necessary for you to contact your insurance company or supply additional information to them for claims processing requirements or to expedite payment.
There are several reasons why your insurance company may deny your claim. One or more of the following may apply:
Riley at IU Health participates in most major health plans in Indiana. Please review your health plan provider directory and/or consult with your insurance company to confirm coverage.
When you register for services at Riley at IU Health, please present your current health plan identification card.
Health Maintenance Organizations (HMOs) require you to select a Primary Care Physician to coordinate your care. Most HMOs provide care through a network of hospitals, doctors, and other medical professionals that you must use in order to be covered for services provided.
Preferred Provider Organizations (PPOs) provide care through a network of hospitals, doctors, and other medical professionals. When you use healthcare providers within the network, you pay less money out of your pocket. Services received from a non-participating hospital or doctor may still be covered, but often with greater out-of-pocket expense for you.
If you receive your healthcare services from a hospital, physician, or other healthcare provider that participates in your health plan, they are often referred to as "in-network." Hospitals, physicians, or other healthcare providers who do not participate in your health plan may be referred to as "out-of-network."
Your benefit book or provider directory should have this information. If not, call the customer service phone number listed on your identification card.
If you did not contact your primary care physician or your insurance company before you came to the emergency room, you will need to contact them within 24 hours of receiving services to explain the circumstances and ask for authorization.
One or more of the following may apply:
If your EOB states that the services you received were out-of-network, consult your insurance company. If you have further questions about your account, you may also contact Patient Financial Services.