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Insurance Coverage

If your primary insurance is:

  • Medicare or Medicaid: The hospital will bill Medicare/Medicaid and may send you a courtesy copy of your itemized bill. Medicare/Medicaid will notify you when they have paid their portion of your hospital bill. If you have a secondary insurance, as a courtesy, the hospital will also send them a bill for the remaining portion and that company will contact you to let you know when and what they paid to the hospital. After payments are received from your primary and any secondary insurer, any outstanding balances will be your responsibility, if applicable.

Occasionally Medicare patients may be asked to sign an Advance Beneficiary Notice should their physician order a chemotherapy regimen that may not be covered by Medicare. An Advance Beneficiary Notice, or ABN, is a written notice from Medicare given to you before receiving certain items or services, notifying you that: Medicare may deny payment for that specific treatment. You will be personally responsible for full payment if Medicare denies payment. Medicare requires our office to have you sign this form prior to services being rendered. An ABN gives you the opportunity to accept or refuse the items or services and protects you from unexpected financial liability in cases where Medicare denies payment. It also offers you the right to appeal Medicare’s decision.

  • An Individual/Group PPO or HMO: The hospital will bill your insurance company. You will be responsible for any deductible and/or co-payment amounts. Payment for these items may be expected at the time of service. Insurance verification will help us to identify your appropriate deductible and co-payment amounts.
  • If You Do Not Have Insurance Coverage: Abington Hospital – Jefferson Health will work with you to determine if you qualify for some type of assistance or a payment plan.

Coordination of Benefits

Most insurance companies are sending letters to subscribers the first of the year requesting to know if the subscriber or dependents has any other insurance coverage. This information must be completed. We need to have birth dates, as well as the social security number of the subscriber, if different from the patient, on file in our office. Your insurance will not pay on claims until they receive this information. If you have questions, please call Abington Hospital’s Business Office. Please see “Questions about Billing” for the telephone numbers to call.

Pre-Certification

Many procedures or treatment plans require pre-certification by your insurance company to verify benefits and obtain preauthorization and approval. Our office does the pre-certification. If you have questions concerning verification of benefits or preauthorization please contact our Insurance Coordinator at 215-481-2166. If it is determined that you have may have a large out-of-pocket expense, someone from the billing department will meet with you to discuss payment options prior to your procedure.

Questions To Ask Your Insurance Company

Use these questions as a guide when you talk to your insurance company about your coverage options. Be sure to make note of the name of the person you spoke with and the date.

  • What type of insurance plan do I have?
  • Am I eligible to have a case manager?
  • Are Abington Cancer Care and Abington Hospital in my network? If so,
  • Does my insurance plan cover physician costs, as well as inpatient and outpatient hospital services?
  • What, if any, are my co-payments and deductibles for the physician’s office?
  • What, if any, are my co-payments and deductibles for the infusion center, a hospital outpatient department?
  • What is my coverage for prescription medications?
  • If Abington Cancer Care and Abington Hospital are not considered in-network and I elect to go out-of-network, what percentage of my bill will I be liable to pay?
  • Before I see a doctor, do I need a referral from my primary care physician, or will I need authorization from my insurance carrier?
  • Will I be covered for any testing, pathology, or radiology charges that may be incurred as part of my initial consultation with an Abington Cancer Care doctor?
  • Is the percentage of my bill paid by the insurance company based upon “allowed” rates or on the actual charges?
  • Does my insurance plan offer any additional coverage through special networks for treating medical conditions such as cancer?
  • Does my policy have an out-of-pocket maximum?
  • If my out-of-pocket expenses reach a certain amount, will the insurance carrier ever reimburse at 100 percent?
  • If so, does this mean that my claims will then be paid in full, or will I still be responsible for the difference between Abington Hospital’s charges and allowed rates?
  • If my referral or authorization is denied can I appeal the decision? Can I expedite the appeals process and where should I mail my appeal letter? What additional information should I include with my letter of appeal and the billing invoice?

Abington Health Physicians