FAQs about St. Mary Billing

Yes, payment arrangements may be made by contacting the Customer Service Department via Avadyne Health Monday through Friday 8 a.m. to 4:30 p.m. (Central Time), by calling Avadyne Health at 1.855.264.4850.

Avadyne Health is St. Mary Medical Center’s self-pay billing division for all processing and follow up of patient balances.

When services are provided by a physician specialist (emergency room physician, cardiologist, pathologist, radiologist, etc.), he/she is required by law to submit a bill for their individual services separate from the hospital's bill.

Yes, St. Mary Medical Center will submit the bill to your insurance carrier and will assist when problems arise. You are requested to supply the pertinent billing information at the time of scheduling or registration. You must also provide any referral(s) if applicable for the specific date of service.

Some insurance providers will send a questionnaire that must be completed in a timely manner for your claim to be processed and payment issued to your providers. Insurance companies are required to update their patient information and determine eligibility. This process is called a COB or Coordination of Benefits. Please complete and return this form as soon as you receive it.

Yes, you are welcome to contact our Customer Service department Monday through Friday between the hours of 8 a.m. and 4:30 p.m. at 215.710.6500.

Financial Assistance is a community benefit offered by St. Mary Medical Center. Applications can be obtained by calling our Customer Service department Monday through Friday between the hours of 8 a.m. and 4:30 p.m. at 215.710.6500.

For an account to be billed as an inpatient service there must be a physician order. The physician who ordered your services determined that your condition did not meet the requirements for an inpatient admission. The physician’s written order dictates whether we bill as an inpatient or outpatient.

For an account to be billed as an inpatient service there must be a physician order for admission. The inpatient determination is driven by the physician order to admit and his/her expertise that the level of care necessitated an inpatient status.

Your insurance carrier may deny the claim for one or more reasons. It is always best to call member services at your insurance carrier to discuss your account. Some common reasons are:

• You were not covered by your plan on the date of service.
• The patient cannot be identified.
• The primary physician did not issue a referral.
• The service was not authorized.
• The service that you received was out of network.
• The balance is due to the patient's deductible and/or co-pay.
• The account denied as "other insurance carrier is primary."
• The insurance premium was not met
• Your insurance carrier deemed the service not medically necessary
• The COB (Continuation of Benefits) questionnaire was not returned or was incomplete.

Deductibles are provisions that require the member to accumulate a specific amount of medical bills before any benefits are paid. Once the patient/insured has met their deductible, the insurance carrier usually pays a percentage of the bill. The patient may be liable for the unpaid percentage.

Co-insurance and/or co-pay is the portion due by the patient and/or insured. Managed care carriers charge co-pays for varied services. For example, emergency room visits, specialist, physical therapy and mental health services.

Depending on your individual plan, insurance carriers require you to pay a deductible and/or co-insurance. Please refer to your insurance plan booklet for more details or call the phone number listed on your insurance card for more details.

The Business Office of St. Mary Medical Center will make every effort to resolve the account balance with your insurance carrier. Occasionally, we will be unable to resolve the issue with your carrier and will need your assistance.

Read your insurance booklet to be sure you have followed all the guidelines for referral and authorizations, or call member services at the phone number listed on your medical card at your insurance carrier for assistance. Failure to follow your plan requirements may result in greater out-of-pocket expenses. Your primary care physician plays a very important role in this process. Should you receive a written referral or a verbal authorization number, please provide us with this information at time of scheduling or at registration.

If you did not contact your primary care physician or your insurance plan before you came to the emergency room after receiving services, you may need to contact them within 24 hours to explain the reason of your visit. Please refer to your insurance plan booklet or call the phone number listed on your insurance card for more details.

Your benefit booklet, provider directory, or physician’s office should provide this information for you. If not available, call your member service unit at the insurance carrier and they should be able to help you. Employees can speak with their benefits coordinator.

When your personal information changes you should always notify the hospital and/or medical providers of the change by contacting the Customer Service Department at 215.710.6500.

When you experience any changes to your insurance coverage, you should contact all the providers that offered medical services to you. Changing coverage includes staying with the same insurance company but choosing a different benefit plan.

Consult your health plan’s member services unit.

When you are involved in an automobile accident, contact the adjuster at your automobile insurance carrier immediately. The adjuster will give you a claim number specific to the accident and request that you complete and return a questionnaire that describes how and when the accident occurred. You may receive a questionnaire from your insurance company. The questionnaire must be returned promptly and notably to your insurance carrier, before any benefits will be paid out. Telephone the Customer Service department of St. Mary Medical Center Monday through Friday, 8 a.m. to 4:30 p.m. at 215.710.6500 to offer the appropriate insurance information for billing. Also, be sure to provide any medical insurance information including a referral or authorization, if this is a requirement of your health insurance carrier in the event your auto insurance is exhausted. This will enable us to bill your health insurance carrier for any remaining balances due after your auto insurance carrier has paid their portion.

Telephone the Customer Service department of St. Mary Medical Center Monday through Friday, 8 a.m. to 4:30 p.m. at 215.710.6500 with the name of the employer's workers compensation insurance carrier and the appropriate insurance information for billing. Also, be sure to provide any medical insurance information so that we can bill your medical carrier if the service is denied by the workers compensation carrier.

If you received medical services during a time when you did not have health insurance, contact the Customer Service Department of St. Mary Medical Center at 215.710.6500 immediately. A service representative will inform you of the varied options available.

• AARP
• Aetna
• Amerihealth
• Americhoice
• Blue Cross
• Bravo Health
• Cigna
• Health Partners

Middletown Anesthesia 
888.216.2675

St. Mary Physician Group - LPS/SMPG 
215.710.7045

Team Health / ER Physician Billing 
800.837.9910 or 888.952.6772

To request a price estimate electronically, please contact us at 215.710.5553. 

Also, see St. Mary Medical Center - Price Estimates for more information. 

Note: Due to the complexity of some services provided at the time of service, we may or may not be able to provide a cost estimate.

If you have questions about your Medicare plan, contact them by calling the phone number listed on your Medicare card or by dialing 1.800.633.4227. You may also log on to www.medicare.gov for more information.

Medicare requires St. Mary Medical Center to notify them when you receive care regardless of your status.

Medicare pays only for a test that is considered medically necessary. If the diagnosis given by your doctor is not one of the diagnoses Medicare will accept for the test, the test will not be considered medically necessary and Medicare will not pay for the test.

Your doctor has made a medical judgment that you need the test. When your doctor says a test is medically necessary they consider your personal history, the medications you are taking and generally accepted medical practices.

We ask patients to sign an ABN whenever Medicare appears likely to deny for payment for a specific service. Medicare requires that we provide patients with a written notification whenever it is likely that you will be responsible for the bill.

We support price transparency. For our patients to understand their potential financial liability for hospital services, we are making our hospital charges available to patients. Hospital charges vary based on the type of care provided. The price can differ from patient to patient for the same services. The price will be different for complications or different treatment for the patient's personal health condition. Patients also may qualify for financial assistance. Please contact 215.710.5553 for a price estimate or to find out if you qualify for financial assistance.