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Billing & Insurance


Our friendly and knowledgeable patient account representatives in our business office are here to help you understand your bill as well as access financial assistance if needed.

How Billing Works

Coquille Valley Hospital will submit claims directly to your insurance company for payment.
Our registration personnel will ask you for your insurance information each time you visit. Providing complete insurance information at the time of registration will assure your account is billed correctly.

Once all insurance payments are applied to your balance, you will receive a statement notifying you of the amount you owe. Regardless of insurance coverage, patients are ultimately responsible for payment of their medical bills.

Payment of all known deductibles, co-payments, and non covered services for pre-scheduled procedures and admissions will be requested prior to services being rendered.

Insurance

Below is a list of health insurance plans with which we contract.

Aetna Commercial
Advanced Health
Cigna Network
First Choice Network
Health Net
Medicare
Medicaid/Oregon Health Plan
Moda (Connexus Network)
Moda Medicare Advantage
Pacific Source Commercial
Pacific Source Medicare Advantage
Providence
Regence Blue Cross/Blue Shield of Oregon
Regence Medicare Advantage
Tricare West
United Health Care
Veterans Choice Program (referral basis only)

It is best to always verify with your insurance to see which providers/facilities are networked.

The list above represents insurance companies we most commonly bill on behalf of our patients. This list is subject to change and may not include all insurances we bill.

Paying Your Bill

We offer several payment options, including revolving payment plans and/or loan options to patients unable to pay their hospital charges in full.

Our payment options include:

Payment in full. We accept cash, check, money order, or major credit card
Pay online using our quick pay site
Approved equal monthly payment plan based on balance due
Monthly payment plan offered through Access One Financial, subject to a minimum payment schedule and    applicable interest for payment plans over 24 months.

Uninsured, Underinsured and Financial Hardship Patients

As a charitable organization, Coquille Valley Hospital provides medically necessary services for free or at a reduced cost for patients that qualify under Coquille Valley Hospital's financial assistance program. The amount of financial assistance that a patient receives under CVH's financial assistance program varies depending upon individual financial circumstances.

If you have questions or need help filling out the Financial Assistance Application, you can contact the CVH Business Office at: (541) 824-1254.

Billing & Insurance FAQ

Who can I call with questions about billing?
The Patient Financial Services Department is available to help Monday through Friday from 8:30 a.m. to 5:00 p.m. Please call (541) 396-3101.

What types of payment arrangements are available?
Special payment arrangements can be made if you do not have insurance or have a balance due after your insurance payment. Our payment options include:

Payment in full. We accept cash (in person only), check (please list your encounter number on the check), money order (please list your encounter number on the money order), or major credit card (Visa, MasterCard or Discover).
Approved equal monthly payment plan based on balance due
Monthly payment plan through Access One, subject to a minimum payment schedule and applicable interest for payment plans over 24 months.

What if I don't have insurance?
As a charitable organization, Coquille Valley Hospital provides medically necessary services free or at a reduced cost to uninsured or underinsured patients who qualify under CVH's financial assistance program. The amount of financial assistance that a patient receives under CVH's financial assistance program varies depending upon individual financial circumstances. Please contact our business office for assistance at (541) 396-3101.
Financial Assistance Application: English    Spanish

What am I responsible to pay when I visit the hospital?
Your insurance will probably include a cost sharing feature where you pay a portion of the fee for the cost of medical care after the deductible has been satisfied.

Deductible - A fixed dollar amount that must be paid prior to eligibility for payment of covered services.

Co-pays - Members pay a fixed dollar amount, for example, $20 for outpatient office visit, and $50 for an Emergency Room visit.

Co-Insurance - Members pay a fixed percentage of the cost. For example, the patient pays 20% and the insurance company pays 80% of the allowed amount.

Why am I getting a bill months after I was treated?
Some insurance plans take up to 90 days or more to pay a claim. The patient is not sent a statement until your insurance has processed your claim.

Why am I receiving correspondence from Resolution Resource?
Resolution Resource is an extension of our hospital, and operates on behalf of Coquille Valley Hospital to send statements and manage payment arrangements. They are not a collection agency.

Insurance Glossary

Assignment of Benefits: The transfer of the right payment of insurance benefits to be paid directly to the health care provider of service.

Birthday Rule (COB): Used to determine primary and secondary coverage for children. The birthday rule refers to only the month and day in a calendar year, not the year in which the parent was born.

If the parents have the same birthday, the insurance plan that has been in effect for the longest time is considered the primary    insurance.
If the parents are not separated/divorced, the insurance of the parent whose Birthday occurs first in a calendar year is considered the    primary insurance.
If the parents are separated/divorced and there is more than one insurance plan covering the child, the primary insurance is    determined in the following order:

1. The insurance plan of the parent with legal custody of the child
2. The plan of the spouse of the parent with legal custody of the child
3. The plan of the parent who does not have legal custody of the child

Co-insurance: The percent of your medical bill benefits you are expected to pay as determined by your health insurance carrier.

Contractual adjustment: The difference between the insurance companies contracted rate of payment with the provider and the amount of the charge.

Coordination of Benefits (COB): A group policy provision which helps determine the primary carrier in instances where the patient is covered by more than one insurance policy.

Co-payment: The amount you are expected to pay (such as amount for each physician visit) as determined by your health insurance policy.

Deductible (DED): The amount the insurance company assigns as patient liability prior to their calculation of insurance payment amount.

Explanation of Benefits (EOB): An explanation of insurance payment, adjustments and any residual balance of claim processing sent to the insured and provider of service by the insurance company.

Health Maintenance Organization (HMO): Health care plans where the member is assigned or chooses a PCP who manages their health care. The PCP must provide the care or authorize any specialty services in order for the services to be paid. Under these plans, the patient is typically responsible for only their co-pays as long as the services are PCP approved.

Managed Care: Insurance managed medical delivery system that manages the quality and cost of medical services.

Medicare: A federal insurance program for individuals age 65 and older, as well as younger disabled or dialysis patients. Medicare Part A covers in-patient hospital services, nursing home, home health and hospice care. Part B covers outpatient hospital services, physicians' services, medical equipment and supplies and other health services and supplies.

Medicare Supplement: A private insurance policy to help pay the balance covered charges after Medicare benefits payment.

Non-covered services: Charges/services that the insurance company determines is a cost they do not consider for payment. These charges/services are normally the responsibility if the patient/guarantor to pay.

Out-of-Network: Most managed care insurance plans are contracted with a specific group of health care providers of service. If a patient requests health care outside this specific provider group with a provider not contracted to provide care, the patient/guarantor may be financially responsible for some or all of the cost of the care received, depending on the determination made by the insurance carrier. Normally, exception is made to this rule for emergency medical care.

Preferred Provider Organization (PPO): Health care plans that allow patients to direct his/her own healthcare. The patient can self-refer within the network of contracted providers. He will be responsible for deductible and normally a percentage of the allowable benefit amount. The patient may choose to go outside the PPO network to receive care and be responsible for higher deductibles and out-of-pocket amounts. The patient is responsible for obtaining authorizations for some types of services.

Primary Care Physician (PCP): Many insurance plans require members to choose or be assigned to a PCP who is responsible for providing or authorizing all medical care for the patient.

Prior Authorization/Pre-certification: Advance formal approval required by the insurance company prior to medical services being rendered. The insurance company approves services based on their determination of medical necessity, appropriateness, and other pertinent factors. Emergency services are not prior authorized, but in most cases must be reported to the insurance company within twenty-four (24) hours.

Referral: A physician's medical order for consultation/services for the patient with a specialist.

Self-Pay: Patients who do not have insurance or those who are not approved to seek services at a particular health care provider are considered a self-pay patient who is expected to pay for the medical services they receive.

Subscriber/Insured: The person who is enrolled for benefits with the insurance company, either under group plans, private or governmental agencies.

UB04 and 1500 Claims Forms: Federally mandated insurance claim forms used to bill medical bills to insurance payer. The UB04 form is used for hospital/clinic technical charges billing. The 1500 claim form is used for physician professional charge billing.

Chargemaster

The Centers for Medicare & Medicaid Services (CMS) final rule for FY2019 requires that hospitals make public a list of their standard charges. Effective January 1, 2019, hospitals are to make available a list of their current standard charges in a machine-readable format. The list of standard charges must be updated annually, or more often as appropriate. This mandate applies to all hospitals, including IPPS Hospitals, Inpatient Rehabilitation Facilities, Inpatient Psychiatric Hospitals, Critical Access Hospitals and Sole Community Hospitals operating within the United States

CMS Hospital Price Transparency

Price transparency can be confusing at times, especially when it comes to healthcare. A major difficulty is that the hospital price is not the actual cost of the out-of-pocket costs for healthcare services that patients will receive. It depends on their insurance coverage.
A chargemaster is a comprehensive list of charges for each inpatient and outpatient service or item provided by a hospital. It is not a helpful tool for patients to comparison shop between hospitals or to estimate what healthcare services are going to cost. The payment amount that hospitals receive for patient care do not necessarily reflect the prices in the chargemaster.

For Insured Patients:

When reviewing charges, it is important to note that actual payment rates for hospital care provided to insured patients are:

• Negotiated with health plans
• Set by the federal government for Medicare
• Set by state government for Medicaid

If you have private insurance and are interested in understanding what your "out-of-pocket" costs may be for the care you receive at the hospital, your health care insurance company will be in the best position to help you understand these costs, and we encourage you to contact them.

For Uninsured Patients:

We offer a discount for patients who do not have health insurance coverage and uninsured patients may be eligible for financial assistance through the Financial Assistance Program. At our hospital, all patients will be treated fairly and with respect during their treatment, and regardless of their ability to pay for the services they receive.
Patients without insurance will be offered reasonable payments and payment schedules and, subject to their acceptance offer, will be billed at discounted local market rates. CVH offers assistance to qualify for Hospital Presumptive Eligibility or standard OHP coverage. Our staff provides application assistance for both programs.
In general, the treatment plan can introduce various levels of complexity that include the patient's insurance plan, specific benefits chosen by the patient; any specifics between the hospital and the insurance plan, length of time spent in the hospital or facility, additional diagnostic tests, lab work, or procedures needed; or any other unforeseen conditions or circumstances that arise during your care or recovery. All of these factors can impact the out-of-pocket costs to each patient.
We are committed to providing price information to our patients. Coquille Valley Hospital provides individualized cost estimates for all services, upon request.

Chargemaster