Frequently Asked Questions about Billing
What is the Medicare contractual adjustment?
The contractual adjustment is the dollar difference between what the hospital or physician billed and what Medicare has approved for payment. The amount is customarily written off by the healthcare provider who accepts Medicare assignment.
Do all University of Chicago physicians accept Medicare assignment?
Yes, all University of Chicago physicians accept assignment.
Can I send my own claims to my insurance company?
Medicare, Medicaid and most major insurance companies do not allow beneficiaries to submit claims, however some secondary plans do. Keep in mind that if you submit a claim incorrectly, it could cause more problems than it might prevent. Beneficiaries submitting claims, is against Medicare rules.
I have insurance coverage, but I want to pay cash. Will you still have to bill my insurance?
Not necessarily. The university billing offices receive billing info from the respective clinics that provide you patient care. If cash payments are made, specific information regarding the dates and medical services must be provided to the hospital cashiers to insure that each service billed is correctly matched with your cash payments. Once your cash payment is posted to the correct service; no bill will need to be sent to your insurance plan. Keep in mind, you may lose any of your insurance plan payment discounts or special rates if you fail to submit a claim and pay cash. This is not recommended if you have Medicare ( Medicare requires providers to submit claims) or an HMO plan (you shouldn't have to pay anything).
I have Medicare primary, but I want my other insurance plan to pay first because they pay more. Is this OK?
No. If Medicare is your primary insurance (and Medicare will make this determination) it will pay your claims first and all other plans you have will be required to pay afterwards. If Medicare considers itself secondary, the agency will notify you and your provider. When Medicare is secondary, it pays your claims only after some other primary insurance plan pays.
Why is the statement mailed to me when I don't owe anything?
If you receive a monthly statement listing posted charges without payments, consider it an informational statement only. The statement will say, "your insurance has been billed. You will be notified." Statements are a record of your services provided by the hospital and the physicians group.
Why do I receive two statements; one from The University of Chicago Hospital and another statement from The University of Chicago Physicians Group?
Hospitals and physicians are required to bill patients and third-parties (insurance plans, agencies) in different ways, using different systems of coding and documentation methods. Medicare has two different plans. Medicare Part A is for hospital and other facility payments. Medicare Part B is for physician and other medical service payments. As such, we have two business offices: U of C Hospital Finance and U of C Physicians Group, each of which send a monthly statement.
There's a charge on my statement for a day when I didn't see a physician. What is this charge for?
In Radiation Oncology and several other specialty clinics, special tasks must be performed before a patient's treatments can begin. These services usually occur behind the scenes, but are extremely important to excellent medical care. Physicists and technicians work in Radiation Oncology to prepare numerical dose calculations, plans and protection devices for exacting radiation therapy when you, the patient have already left the clinic. However, their work must be completed before you return to begin radiation treatments. As a result, you may find dates on your monthly statement which do not coincide with a day when you were present in our clinic.