Frequently Asked Questions About Your Hospital Bills
How will I be billed?
When you receive medical services at Exempla, we will bill your insurance company first. Once we learn the amount your insurance company will pay, we will send you a bill showing this information and the balance you owe. This normally takes 45 - 60 days. The balance you owe is due when you receive the bill.
Why have I received multiple bills?
Some health care providers who cared for you in the hospital are not Exempla employees. They have their own businesses and billing offices. You may receive bills from emergency room physicians, anesthesiologists, pathologists, radiologists and other physicians involved in your care. For questions about these bills, please call the office number listed on the bill sent by these physicians and other providers.
What is my role in the billing process?
There are several things you can do to make the billing process as efficient as possible. These include:
At registration, provide correct information about your insurance, date of birth, social security number, employer, and your contact information.
Work with your insurance company to secure the needed pre-authorizations.
Determine whether Exempla is considered in-network or out-of-network for your health insurance plan. If Exempla is an out-of-network provider, you may have to pay an additional cost for our services.
Secure copies of your medical records as needed.
Sign release forms as needed.
Communicate with us in a timely manner if you are having difficulty paying your hospital bill.
What do I need to bring with me to the hospital for the billing process?
Bring your insurance card, co-pay required by your insurance company and photo identification.
What insurance coverage does Exempla accept?
Exempla has contracts with nearly all insurance companies. Please call your insurance provider to confirm your coverage.
Is Exempla In-Network or Out-of-Network?
Be certain to check with your insurance plan to see if Exempla is an in-network or out-of-network provider for your plan. In most cases, Exempla will be an in-network provider. If Exempla is an out-of-network provider, you may have to pay an additional cost for our services.
What forms of payment does Exempla accept?
Exempla accepts cash, checks, check by phone, Visa, MasterCard, Discover, American Express, cashier's checks, money orders and travelers checks.
What do I do if my insurance didn't pay my hospital bills?
While we understand this can be a surprising situation, your hospital bill is your responsibility. If you are having difficulty paying the bill, please contact a Customer Service Representative at 303-813-5400 who will be happy to help you with payment terms or financial assistance.
Why don't all patients pay the same thing for the same procedure?
Prices vary in part because each patient is different and the cost of providing care is different. For example, Medicare patients are older and typically have more complications. Additionally, the prices vary because different insurers have negotiated different rates and discounts with Exempla. In some cases, the payment to Exempla (from the insurer and any co-pay from you) may not cover the actual costs to Exempla for the care if our contract with an insurer, or Medicare regulators, sets payments below our costs.
What do the different numbers mean that go into hospital "costs" and hospital "prices?"
Your share. The most important number is what you will have to pay. This depends on your insurance coverage, and your insurance company is your best source of information on your co-pay and deductibles. If you have no insurance, we offer discounts, charity, and payment terms.
Exempla's costs. We track Exempla's costs for each case - direct costs of supplies and staff, and allocations of support services. Our costs differ for each case, because each patient can require different treatment, even for the similar diagnoses.
Expected payment. We also track Exempla's payment for each case from you and from your insurance company. In some cases payments are more than our costs (most insurance companies pay higher than our costs), and in other cases payments are less than our costs (usually Medicare, Medicaid and uninsured cases).
Gross charges. The least important number that we track is our gross charges. Nearly all hospitals have gross charges that are much higher than costs or expected payment (sometimes two to three times higher). Gross charges are the basis upon which hospitals calculate discounts to insurers. Gross charges are like full-fare coach on airplanes: it's a price that rarely ever applies. They are also the number current used most often to make price comparisons between different hospitals.
Why are hospital bills so high?
Health care is an essential, complicated, high-technology and labor-intensive service that must be available to everyone 24-hours a day, 7 days a week, 365 days a year. To properly care for patients, hospitals must hire outstanding and highly trained doctors, nurses, technicians and other professionals. Hospitals also must purchase expensive, state-or-the-art equipment and maintain first-class facilities.
While we incur all these expenses, Exempla also provides care for patients regardless of their ability to pay, and does not receive full payment for its services from most government insurance plans.
Where does my health care dollar go? The following chart shows how $1.00 in hospital gross charges is spent to provide care for Exempla patients. You'll see that nearly $.71, or 71%, of our gross charges are never recouped due to insurance discounts, discounts to self-pay patients and uncompensated care.