Thank you for choosing WVU Medicine for your medical needs.

We are committed to providing the highest level of care to all patients. It is important to us that you understand your WVU Medicine bill, and we are happy to answer any questions you may have.

Insurance Coverage

Our healthcare system accepts many insurance plans. As insurance coverage can vary depending on many plan variables, please check with your insurance provider for specific details.

As a courtesy, we will file a claim with your insurance company, based on the insurance information you provide. However, payment for services is your responsibility, and we encourage you to see that your insurance company makes timely payments on your behalf.

Our counselors and customer service staff are familiar with many programs that provide financial assistance and will help you apply for assistance. To be considered for any assistance, you will have to complete a financial statement.

Financial Requirements for Services

University Healthcare and University Health Physicians are committed to providing quality care to patients regardless of their ability to pay. We have established financial policies to assure that every patient has access to our services – and also to assure that we can maintain a strong financial base and maintain these services for everyone.

In emergencies, treatment will not be delayed because of financial or insurance issues. Only after the medical screening examination has been completed and the patient has been stabilized, willUniversity Healthcare and University Health Physicians initiate calls to third party payers to verify insurance coverage’s and for notification of the patient’s arrival in the emergency department. At no time will emergency treatment be delayed because a physician or insurance company cannot be reached or due do a patient’s inability to pay.

For non-emergent care, patients must receive financial clearance prior to receiving scheduled services. Financial clearance can be obtained in the following ways:

  • Authorization and verification of coverage for services under the patient’s insurance plan
  • Approval for assistance under WVU Hospitals’ Financial Assistance Policy
  • For uninsured patients who are not eligible for government programs or eligible under WVU Hospitals’ Financial Assistance Policy, advance payment is expected 72 hours prior to the scheduled service. Discounts may be available.

Emergency cases completing treatment and having been stabilized will be requested, prior to discharge, to comply with the same financial requirements as non-emergency unscheduled patients. Patients admitted to WVU Hospitals to stabilize their condition without meeting financial resolution requirements, will be identified and monitored post stabilization for resolution prior to discharge.

Understanding Your Healthcare Benefits

Non-Covered Services
Every employer’s benefit plan design is different. Some categories of services may be covered under one plan, but not covered under another plan. Please review your plan closely before receiving scheduled services to make sure that the service is a covered benefit under your plan.

Services that may not be covered include:

Non-emergent service provided in an emergency room setting
Family planning services
Services deemed to be cosmetic in nature
Services not considered medically necessary

To determine whether a service is covered, please contact your insurance company to inquire about benefit levels for planned services. If you receive a service that is not covered under your benefit plan, the balance will be your responsibility and will be billed to you directly. If a service is deemed not to be covered by insurance, you may be eligible for a discount. For information on discounts for your hospital bill, please contact University Healthcare and University Health Physicians at 800-516-5548.

Acute Inpatient vs. Outpatient Services
Your illness, condition or medically necessary service may not require inpatient hospitalization. However, your physician may request that you be assigned to a hospital room for a period of monitoring until there can be a more definite determination of your healthcare needs. At intervals during your stay, your attending physician and our care management team will evaluate whether you will require admission to the hospital as an inpatient. If you are not admitted and you have insurance, the hospital will file a claim for outpatient services and your insurance will apply outpatient benefit levels when processing the claim (including any deductible or coinsurance that may apply). If you have Medicare, you will also be responsible for any drugs that Medicare considers “self-administered”. You may bring any prescription medications with you to avoid these added costs.

If you have Medicare and would like more detail, please review CMS publication 11435.

Your Portion of Your Healthcare Expense
You pay for your health insurance in two ways: premiums and out-of-pocket expenses.

Your premium is a monthly amount to purchase your health insurance plan.

You also may have the following out-of-pocket expenses that will be required when you receive healthcare services. There are a few different kinds of out-of-pocket expenses. Your plan may have all or none of these.

  • Deductible – the amount you have to pay every year before your health insurance begins paying for its share of your services. Like your auto or homeowners insurance, this is a fixed amount (for example, $1,000, $5,000, or $10,000). Some plans reach the deductible based on each individual’s expenses and some are based on the expenses of the whole family. Some services (like preventative care) may be excluded from the deductible depending on your plan.
  • Copayment (“Copay”) – A fixed expense for each visit of a certain type of care. The most common would be a doctor’s office visit (e.g. $25) or for emergency room care (e.g. $100).
  • Coinsurance – The percentage of your medical cost that you are responsible for paying. If you have an 80/20 plan, your insurance will pay 80% of the bill, where you are responsible for 20%.
  • Out-of-Pocket Maximum – This is the most of your healthcare cost that you will be expected to pay in a single plan year. Once you have paid the out-of-pocket maximum, the insurance plan will no longer apply coinsurance to your bills and will pay 100% of the allowed expenses.

Example (for illustrative purposes only):

It is the beginning of your plan year. Your plan has a $1,000 deductible, 20% coinsurance and a $2,000 annual out-of-pocket maximum. You are admitted to the hospital and incur a bill of $50,000.
out-of-pocket-maximum

 

 

 

 

If you have questions about your healthcare benefits, please contact your insurance company directly, contact our financial counselors at 304-596-6836, 304-596-6820 or 304-724-3551

Estimating your Healthcare Expense

Estimate for a Specific Service
Hospital bills vary greatly depending on the type of service and resources utilized during your hospital stay. We can help you to estimate your expense by taking into account the average expense for the service that you are planning, as well as our agreement with your insurance (if any) and your current insurance benefits (if any). Please contact a financial counselor to receive an estimate: BMC 304-596-6820 304-596-6836  JMC 304-724-3551

Standard Charges
It is the policy of West Virginia University Hospitals, Inc. to allow the public to view the hospital’s standard charges in compliance with the Affordable Care Act, which amended Section 2718(e) of the Public Health Service Act. Our policy is aimed to promote price transparency for patients in order to help them understand their potential financial liability for any service provided at our hospital, and to allow consumers the ability to comparison shop for similar services across hospital providers.

Understanding the Bill for Your Visit

Hospital Inpatient/Observation/Diagnostic Services
Ruby Memorial, Children’s Hospital, and Chestnut Ridge Locations

It is important for you to understand that charges for the care you received while you were a patient in the hospital will be on separate invoices. Your hospital bill does not include charges for physicians’ care. You will receive two separate bills — one from University Healthcare and University Health Physicians for the hospital services and one from University Healthcare and University Health Physicians for physicians’ services.

Your hospital bill will include charges for:

  • The cost of your room
  • Medications
  • Medical supplies
  •  Laboratory services
  • Other diagnostic tests such as x-rays
  • Use of the operating or procedure rooms
  • Inpatient therapy
  • Other services

Your physician’s bill will be mailed to you by University Healthcare Physicians. Billing by University Healthcare Physicians includes fees for the doctors directly responsible for your care, as well as those who interpret tests, read X-rays, and perform other services such as anesthesia and pathology services.

Provider-Based Clinic Services
Physician Office Center, Heart Institute, Cheat Lake Physicians and University Town Center Locations

WVU Hospitals has a few “Provider-Based” clinic locations. “Provider-Based” refers to services provided in hospital outpatient departments that are clinically integrated into a hospital. The clinical integration allows for higher quality and seamlessly coordinated care. “Provider-Based” status is a designation for hospitals and clinics that meet specific government regulations and requires that we bill Medicare and other payers in two parts — one bill for the physician service (from University Healthcare Physicians), and another bill for the hospital/facility resources and services (from University Healthcare).

Your hospital bill will include charges for:

  •     Use of the examination room and nursing services (clinic charges)
  •     Medications used during your visit
  •     Medical supplies
  •     Laboratory services
  •     Other diagnostic tests such as x-rays
  •     Use of procedure rooms

Your physician’s bill will include fees for the doctors directly responsible for your care, as well as those who interpret tests, read X-rays, and perform other services.

Billing and Collections Process for your Hospital Bill

  •     Once your out of pocket expense has been determined (either by your insurance processing the claim, or after discounts if you have no insurance) a billing statement will be mailed to the Guarantor listed on your account.
  •     Patients who do not provide insurance information prior to or at the time of service will receive a billing statement for the services rendered. Insurance clarification or full payment is required within 30 days of the date of the statement.
  •     If no payment is made by the 21st day after the statement is mailed, we will place a reminder call to the phone number on record. This phone number may be a traditional land line or a cellular phone number.
  •     If no payment is received, additional statements will be mailed on 30 day cycles. Additional reminder calls will also be placed during the billing cycle.
  •     If no payment is received by the 120th day after the first statement, the balance will be placed with an outside collection agency.
  •     If we do not have a valid address and/or telephone number, the balance may be placed with an outside agency before 120 days has passed.
  •     Once an account is placed with an outside collection agency, billing statements and telephone contact will be made solely by the outside agency.

WVU Hospitals’ full Billing and Collections Policy can be reviewed by following the link below. If you have questions about your hospital bill, please call Patient Account Services at 866-354-5461 or visit our offices at 2500 Hospital Drive in Martinsburg, WV or 300 S Preston Street in Ranson, WV

Be sure you understand how your insurance policy covers your physicians’ bills. The coverage of these bills may be different from coverage for hospital charges. If you have questions about your physician’s bill, please call University Healthcare Physicians at 877-988-4847

Bill Payment Options

You may pay your bill in one of three ways:

  •     Pay online (available 24/7)
  •     Pay by phone at 866-354-5461 for hospital payments or 877-988-4847 for Physician payments
  •     Mail payment using coupon on your statement to:

Hospital Payments:

University Healthcare
PO Box 990
Morgantown WV 26507-0990

Physician Payments:

University Healthcare Physicians
PO Box 1049
Morgantown, WV 26507

If you are unable to pay your balance in full, we also offer convenient, zero interest payment plans. If you would like to set up a payment plan, please contact Patient Financial Services:

  •     Hospital Payment Plans – 866-354-5461
  •     Physician Payment Plans – 1-877-988-4847

If you do not have the financial resources to pay your bill, you may be eligible for financial assistance. Please consult our Financial Assistance page for more information.

If at any time you have a question about your bill, please contact us to speak with one of our customer service representatives. Representatives are available Monday through Friday from 8 a.m. to 5 p.m. After hours, leave a message, and we’ll return your call.

For questions about a Hospital bill:  Contact WVU Hospitals Patient Financial Services office at 866-354-5461

For questions about a Physician bill:  Contact University Healthcare Physicians at 1-877-988-4847

Financial Assistance

WVU Hospitals (WVUH) and University Healthcare Physicians (UHP) are committed to providing quality care to patients regardless of their ability to pay. In emergencies, treatment will not be delayed because of financial or insurance issues. The hospital acknowledges that there are patients who do not possess the ability to pay for emergent or medically necessary healthcare services. The following guidelines have been established to provide financial assistance to our patients in need.

Who is eligible for Financial Assistance?
A patient who resides in West Virginia is eligible for 100% financial assistance if he/she:

  •     Has received or is scheduled to receive Emergency or Medically Necessary Care
  •     Has a household income less than twice the federal poverty limit

Sample Income Guidelines for 2015
sample-income-guidelines

 

 

 

 

  •     Does not have substantial assets
  •     Has applied for and has been denied Medicaid coverage
  •     Is a citizen or permanent resident of the United States (foreign students are not eligible)

Patients outside of these guidelines may also be considered on an exception basis.

How do I apply for Financial Assistance?
If you feel that you may meet the requirements above, an application may be obtained from the following sources:

  •     You can download a copy of the application in pdf format here
  •     By calling or visiting the Financial Counselors’ Office at: BMC 304-596-6820 304-596-6836  JMC 304-724-3551
  •     By calling the Patient Account Services Department at 866-354-5461 between 8 AM and 5 PM, Monday-Friday

Please complete all sections of the application form and assemble all required documentation prior to submitting your application. If you need help completing your application, please contact or visit our Financial Counselors by phone at 304-596-6820 or 304-596-6836 or JMC 304-724-3551

Completed applications can be mailed to our Financial Counselors at Berkeley Medical Center 2500 Hospital Drive, Martinsburg, WV 25401 or Jefferson Medical Center 300 S Preston Street, Ranson WV 25438. They can also be delivered to the same addresses between 8 AM and 4 PM, Monday – Friday.

What is covered under Financial Assistance?
All emergency and medically necessary care is covered. Once you are approved, you are covered for 6 months.

What is not covered under Financial Assistance?
Not all services will be covered under Financial Assistance. The following services are excluded:

  •     Elective or cosmetic services
  •     Prescriptions
  •     Routine eye exams for corrective lenses
  •     Maternity services
  •     Reproductive services
  •     Suboxone clinic
  •     Bone Marrow Transplant
  •     Services not considered medically necessary by most insurance companies

For a complete list of excluded services, please contact a financial counselor: BMC 304-596-6820 or 304-596-6836  JMC 304-724-3551

Where can I obtain a copy of your Financial Assistance Policy?
Our full Financial Assistance Policy is available:

  • For download here
  • Via mail by calling our Financial Counselors at BMC 304-596-6820 304-596-6836  JMC 304-724-3551
  • Via mail by calling Patient Account Services at 866-354-5461
  • For pick-up in the admission area, registration in the emergency department of Berkeley Medical Center, Jefferson Medical Center, or Patient Financial Services offices at 2500 Hospital Drive, Martinsburg WV, 25401 or 300 S Preston St., Ranson, WV, 25438.

What if I do not qualify for financial assistance or cannot meet the guidelines above?
If you are unable to qualify for 100% financial assistance as outlined above. You will still be eligible for discounted care. If you are uninsured, you will not be charged more than 50% of our current billed charges for your hospital bill. This discount ensures that you are not charged more than amounts generally billed for patients covered under Medicare and other private health insurers. Discounts may also be available for your physician bills. Please contact 877-988-4847 for more information on Physician discounts. If you have insurance, other discounts may be available for you as well. Please contact our Financial Counselors at: BMC 304-596-6820 304-596-6836  JMC 304-724-3551
or Patient Account Services at 866-354-5461 for more information.

Click to download the Plain Language Summary
Click to download the Financial Assistance Policy
Click to download the Financial Assistance Policy (1608a)
Click to download the Financial Assistance Policy – Spanish
Click to download the Financial Assistance Application
Click to download the Financial Policy – Spanish

Glossary of Terms

Annual Benefit Limit: The maximum amount a health plan will pay in benefits for an insured individual’s healthcare during a plan year.

According the HHS.gov, “The Affordable Care Act bans annual dollar limits that all job-related plans and individual health insurance plans can put on most covered health benefits. Before the health care law, many health plans set an annual limit — a dollar limit on their yearly spending for your covered benefits. You were required to pay the cost of all care exceeding those limits.”

“Plans can put an annual dollar limit and a lifetime dollar limit on spending for health care services that are not considered essential health benefits.”

Benefit: Amount payable by the insurance company to the provider in the case of your access of medical care.

Carrier: The insurance company or HMO offering a health plan.

Claim: A request by an individual (or his or her provider) to an individual’s insurance company for the insurance company to pay for services obtained from a health care professional.

Coinsurance: Co-insurance refers to money that an individual is required to pay for services, after a deductible has been paid. Co-insurance is often specified by a percentage. For example, the employee pays 20 percent toward the charges for a service and the employer or insurance company pays 80 percent.

Copayment: Co-payment is a predetermined (flat) fee that an individual pays for health care services, in addition to what the insurance covers. For example, some HMOs require a $10 “co-payment” for each office visit, regardless of the type or level of services provided during the visit. Co-payments are not usually specified by percentages.

Deductible: The amount an individual must pay for health care expenses before insurance (or a self-insured company) covers the costs. Often, insurance plans are based on yearly deductible amounts for a covered individual or family.

Denial of Claim: Refusal by an insurance company to honor a request by an individual (or his or her provider) to pay for health care services obtained from a health care professional.

Dependents: Spouse and/or children of an insured covered under the insured’s policy.

Effective Date: The date your insurance is to actually begin. You are not covered until the policies effective date.

Exclusions: Medical services that are not covered by an individual’s insurance policy.

Explanation of Benefits (EOB): The insurance company’s written explanation to a claim, showing what they paid and what the client must pay. This will be received prior to you receiving a bill from WVU Medicine for healthcare services.

Group Insurance: Coverage through an employer or other entity that covers individuals in the group.

Health Maintenance Organizations (HMOs): Health Maintenance Organizations are plans where the financial responsibility for your care is delegated to a healthcare provider (your “primary care physician”). The plan is usually more restrictive about which healthcare providers you can use to seek care and require prior approvals or referrals from your primary care physician for specialty care.

HIPAA: “The Health Insurance Portability and Accountability Act of 1996” (“HIPAA”) is a Federal law passed in 1996 which establishes a set of national standards for the protection of certain health information. The Privacy Rule standards within the law address the use and disclosure of individuals’ “protected health information” by organizations subject to the Privacy Rule. They also establish standards for individuals’ privacy rights to understand and control how their health information is used.

In-network: Providers or health care facilities, which are part of a health plan’s network of providers with which it has negotiated a discount. Insured individuals usually pay less when using an in-network provider, because those networks provide services at lower cost to the insurance companies with which they have contracts.

Individual Health Insurance: Health insurance coverage on an individual, not group, basis. The premium is usually higher for an individual health insurance plan than for a group policy, but you may not qualify for a group plan.

Lifetime Maximum Benefit (or Maximum Lifetime Benefit): The maximum amount a health plan will pay in benefits for an insured individual’s healthcare during that individual’s lifetime.

According the HHS.gov, “Thanks to the Affordable Care Act, lifetime limits on most benefits are prohibited in any health plan or insurance policy. Previously, many plans set a lifetime limit — a dollar limit on what they would spend for your covered benefits during the entire time you were enrolled in that plan. You were required to pay the cost of all care exceeding those limits”

“Plans can put an annual dollar limit and a lifetime dollar limit on spending for health care services that are not considered essential health benefits.”

Long-Term Care Policy: Plans that can be purchased to cover services including nursing care, home health care services, and custodial care. Long-Term Care Policy benefits and costs vary greatly between plans.

Length of Stay (LOS): Term used by insurance companies, case managers and/or employers to describe the amount of time an individual stays in a hospital or in-patient facility.

Managed Care: A medical delivery system that attempts to manage the quality and cost of medical services that individuals receive. Most managed care systems offer HMOs and PPOs that individuals are encouraged to use for their health care services. Some managed care plans attempt to improve health quality by emphasizing prevention of disease.

Medigap Insurance Policies: Polices that are designed to pay for some of the costs that Medicare does not cover (including coinsurance and deductible amounts). Medigap insurance is offered by private insurance companies, not the government.

Network: A group of doctors, hospitals and other health care providers contracted to provide services to insurance companies’ customers for less than their usual fees. Provider networks can cover a large geographic market or a wide range of health care services. Insured individuals typically pay less for using a network provider.

Out-of-Network: This phrase usually refers to physicians, hospitals or other health care providers who are considered nonparticipants in an insurance plan (usually an HMO or PPO). Depending on an individual’s health insurance plan, expenses incurred by services provided by out-of-plan health professionals may not be covered, or covered only in part by an individual’s insurance company.

Out-Of-Pocket Maximum: A predetermined limited amount of money that an individual must pay out of their own savings, before an insurance company or (self-insured employer) will pay 100 percent for an individual’s health care expenses.

Outpatient: An individual (patient) who receives health care services (such as surgery or observation services) and does not stay overnight in a hospital or stays overnight, but is not assigned to “inpatient” status based on clinical indicators.

Pre-Admission Review: A review of an individual’s health care status or condition, prior to an individual being admitted to an inpatient health care facility, such as a hospital. Pre-admission reviews are often conducted by case managers or insurance company representatives (usually nurses) in cooperation with the individual, his or her physician or health care provider, and hospitals.

Pre-existing Conditions: A medical condition that is excluded from coverage by an insurance company, because the condition was believed to exist prior to the individual obtaining a policy from the particular insurance company. According to HHS.gov, after Jan 1, 2014, “…health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition””.

Preadmission Testing: Medical tests that are completed for an individual prior to being admitted to a hospital or coming in for a surgical procedure.

Preferred Provider Organizations (PPOs): You or your employer receive discounted rates if you use doctors from a pre-selected group. If you use a physician outside the PPO plan, you must pay more for the medical care.

Primary Care Provider/Physician (PCP): A health care professional (usually a physician) who is responsible for monitoring an individual’s overall health care needs. Typically, a PCP serves as a “quarterback” for an individual’s medical care, referring the individual to more specialized physicians for specialist care.

Provider: Provider is a term used for health professionals who provide health care services. Sometimes, the term refers only to physicians. Often, however, the term also refers to other health care professionals such as hospitals, nurse practitioners, chiropractors, physical therapists, and others offering specialized health care services.

Usual, Customary and Reasonable (UCR) or Covered Expenses: An amount customarily charged for or covered for similar services and supplies which are medically necessary, recommended by a doctor, or required for treatment.