Insurance Information

From understanding your bills, to knowing your patient status, all the way down to making payments and utilizing financial assistance, we know that it can be a complicated process.

It is our goal to make this part of your treatment as painless as possible, and therefore we have provided detailed information on each subject below.

 

Understanding the Bills for Your Hospital Visit

Trying to sort through the various bills you receive from the hospital and doctors in order to coordinate your insurance benefits can be difficult.

The following information is provided in an effort to help you with this process.

The Hospital Bill is Separate from Bills for Physician Services

After your hospital visit, you will probably receive separate bills for the following types of services:

Standard hospital services. These services do not include the physician services described below. This includes room and board, labor and delivery services, medical procedures and other service charges.

Physician services. This includes doctors (such as anesthesiologists, attending doctors, emergency room doctors, hospitalists, pathologists, radiologists, surgeons, etc.), advanced practitioners (such as nurse practitioners and physician assistants), dentists, and those other health professionals who are authorized to treat patients in the hospital. Many health care professionals who provide services are not employed by the hospital. In most instances, these independent professionals bill for their services separately from the hospital bill.

Hospitals are required by law to make available information about their standard charges for the items and services they provide.

For a list of standard hospital charges only, click on your hospital of choice:

In addition, the New York State Department of Health offers a guide to standard hospital services and charges by Diagnosis-Related Groups for St. Peter's Health Partners hospitals.

Hospital Charges Differ Based on the Type of Care Provided

It is important to note that the price can differ from patient to patient for the same services. The price will be different due to complications or different treatment plans for each patient's personal health condition. For a price estimate, please email your request to sphpchargemaster@sphp.com.

Know Your Patient Status – Inpatient Or Outpatient?

Did you know that even if you stay in a hospital overnight, you might still be considered an "outpatient?"

Your patient status (whether the hospital considers you an “inpatient” or “outpatient”) affects how much you pay for hospital services (like X-rays, drugs, and lab tests). It may also affect whether Medicare will cover care you get in a skilled nursing facility following your hospital stay.

You are an inpatient starting when you’re formally admitted to a hospital with a doctor’s order.

You are an outpatient if you’re getting emergency department services, observation services, outpatient surgery, lab tests, X-rays, or any other hospital services, and the doctor has not written an order to admit you to a hospital as an inpatient. In these cases, you’re an outpatient even if you spend the night at the hospital.

Note: Observation services are hospital outpatient services given to help the doctor decide if the patient needs to be admitted as an inpatient or can be discharged. Observation services may be given in the emergency department or another area of the hospital.

The decision for inpatient hospital admission is a complex medical decision based on your doctor’s judgment and your need for medically necessary hospital care. An inpatient admission is generally appropriate when you are expected to need two or more midnights of medically necessary hospital care. But your doctor must order such admission and the hospital must formally admit you in order for you to become an inpatient.

For more information, click here.

Find out Whether our Hospitals and Physicians Participate in your Health Insurance Plan

Our hospitals are participating providers in many health plan networks. Some health plans use smaller networks for certain plans they offer, so it is important to check whether we participate in the specific plan you are covered by.

To find a list of the plans in which our hospitals participate, click on your hospital of choice:

You may also wish to determine what your coverage is for various hospital services such as labs, X-rays and emergency care. Please contact your insurance carrier if you have questions.

Insurance Coverage for Physician Services

The physicians who are part of your care team bill for their services separately. Physicians who provide services at the hospital may be independent or they may be employed by the hospital.

We also contract with physician groups (such as anesthesiologists, radiologists and pathologists) to provide services at our hospitals.

Preparing for Doctor Bills

Check with the physician arranging your hospital services (the doctor who referred you to the hospital) to determine:

  • Which health plans that physician participates in.
  • Whether the services of any other physicians, employed or contracted, are likely to be needed.

If additional physician services are needed, you should find out which health plans they participate in. Your physician can provide you with the name, practice name, mailing address and telephone number of any physicians whose services may be needed.

Contact Information

Contracted Physician Groups (Click on your hospital of choice)

Plan Participation Information for Hospital-Employed Physicians (Click on your hospital of choice)

Note: If your insurance does not cover the entire cost of a service, you will have to pay for some or all of that bill. In some cases, you may be able to apply for reimbursement from your health plan.

Pre-Approval And Pre-Certification

If your health plan requires pre-certification or preapproval of the admission, be sure to notify your plan. Without your plan’s approval, you will have to pay the charges. Insurance questions about your hospital stay should be directed to your insurance carrier.

Financial Responsibility

Your health plan may require that a copayment/deductible/coinsurance be made by you for the services you received. You must pay the copays, deductibles, coinsurance, or non-covered services as set by your insurance plan. Be aware that your financial responsibility may change based on your patient status and the services you receive (See Know Your Patient Status) [Editor’s Note: hyperlink words]).

Any patient who has not submitted insurance information will be responsible for payment of the hospital bill.

St. Peter's Health Partners benefit advocates may visit you during your stay to review your financial responsibility and request payment.

Making a Payment

If you have a copay, payment is expected at time of service. We accept cash, checks, all major debit/credit cards, and health care flexible-spending debit/credit cards.

Financial Assistance

St. Peter’s Health Partners is committed to minimizing financial barriers to health care, especially for those uninsured and those who do not have enough coverage from health insurance or governmental payment programs.

The Affordable Care Act (ACA) requires everyone legally living in the United States to have health insurance beginning January 1, 2014. It also gives millions of individuals with too little or no insurance access to health plans at different cost levels. The law is in place to provide more affordable options to individuals with too little or no health insurance. The law also provides financial assistance to those who qualify based on family size and income.

If you do not have health insurance or are concerned that you may not be able to pay for your care in full, we can help.

How to Get Assistance

Benefit advocates can help you enroll in an insurance plan, including Medicaid, as well as apply for the Financial Assistance Program. If you have an insurance plan, benefit advocates can review your plan and discuss payment plans and other payment options.

St. Peter's Health Partners benefit advocates are available Monday through Friday, 8 am to 4 pm. To reach the benefit advocates at your hospital, contact:

  • Albany Memorial Hospital: 518-471-3297
  • St. Mary's Hospital: 518-268-5501
  • St. Peter's Hospital: 518-525-5230 or 518-525-1565
  • Samaritan Hospital: 518-271-3380
  • Sunnyview Rehabilitation Hospital
    • Outpatient: 518-268-4926
    • Inpatient: 518-382-4516

For all other questions or concerns, contact St. Peter’s Health Partners Customer Service at 518-471-3000 or email SPA-BusinessOfficeCustomerService@sphp.com.

Central Business Office (Billing) Locations:

 

 

Start your journey to hearing better. Come visit us today.

Schenectady (Main)

1270 Belmont Ave.
Schenectady, NY 12308

Guilderland (Satellite)

3757 Carman Rd.
Schenectady, NY 12308

Amsterdam

5032 State Highway 30
Amsterdam, NY 12010

Latham

579 Troy-Schenectady Rd.
Latham, NY 12110

 

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1270 Belmont Ave.
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