General Financial Information
If You Have Health Insurance
- If You Are a Member of an HMO or PPO
- If You Are Covered by Medicare
- If You Are Covered by Medicaid
- If You Have No Health Insurance
Insurance Plans Accepted by Southern Regional
Managed Care 101 - Answers to common questions about Managed Care
- What Is Managed Care?
- How Managed Care Benefits You
- How Managed Care Works to Contain Medical Costs
- Types of Managed Care Plans
- Before You Choose a Plan
- What is a Primary Care Physician
- Managed Care Terms and Definitions
General Financial
Information
From the moment you are admitted until you are discharged, Southern
Regional is committed to providing outstanding service; performing
our responsibilities sincerely and professionally; and anticipating
and responding to your needs. During your stay with us, charges will
be made to your account based on the services that you receive.
These charges are based primarily upon the orders that your
physician has made regarding your medical care. Charges for all
hospital services will be reflected on an itemized bill, which is
available at your request. Southern Regional accepts all major
credit cards (Visa, MasterCard, and American Express).
You may be billed by physicians other than your primary physician
based upon the tests and procedures that are performed. These
charges could include fees by assisting physicians, radiologists,
pathologists, neonatologists, anesthesiologists, Emergency Department
physicians, or nurse practitioners. They will bill you separately
from the hospital. You may also be billed by a physician with the
hospital trauma service, nurse practitioners in the
Community Care Center, or physicians and midwives with the
Women's Life Center.
If you have any questions regarding your bill, please contact our
Patient Accounts Department at 770-991-8130.
If You Have Health
Insurance
We will need you to bring your health insurance card with you to the
hospital. We also may need the insurance forms, which are
supplied by your employer or insurance company. All patients
should familiarize themselves with the terms of their insurance
coverage. This will help you understand the hospital's billing
procedures and charges.
If you are admitted to the hospital, you will be asked to sign a
form assigning all insurance benefits for your stay to Southern
Regional. This form allows us to file with your insurance company
and collect money on your behalf. After you are discharged, we will
send a claim to your insurance company seeking payment. You should
receive a statement from the hospital within 45 days of discharge and
then every subsequent 30 days until the account is resoloved.
We encourage your help in assisting us with collection of the
appropriate amount from your insurance company.
If You Are a Member of an HMO or PPO
Your plan may have special requirements, such as a second surgical
opinion or pre-certification, for certain tests or procedures.
It is your responsibility to make sure the requirements are followed.
If not, you may be financially responsible for all or part of the
services rendered in the hospital. Some physician specialists may
not participate in your health care plan, and their services may
not by covered.
If You Are Covered by Medicare
We will need a copy of your Medicare card for the current month
to verify eligibility and process your Medicare claim. You should
be aware that the Medicare program specifically excludes payment
for certain items and services such as cosmetic surgery, some oral
surgery procedures, personal comfort items, hearing evaluations
and others. For more information on Medicare,
please visit their official
site at www.medicare.gov.
If You Are Covered by Medicaid
We will need a copy of your Medicaid card for the current month.
Medicaid also has payment limitations on a number of services and
items. Medicaid does not pay for the cost of a private room unless
medically necessary. For more information on the Georgia Medicaid program,
please visit the State of
Georgia's Department of Community Health's official
site at www.dch.state.ga.us.
If You Have No Health Insurance
You can discuss financial arrangements with a
representative from our Patient Accounts Department. Their
phone number is 770-991-8130. In addition, this department
can help you with applying for Medicaid or other government
assistance programs.
Insurance Plans Accepted by
Southern Regional
Southern Regional accepts most major health insurance plans.
If you need more information concerning health plans, contact
the managed care department at 770-991-8605.
|
PLAN
|
TYPE
|
|
Aetna |
HMO/POS/PPO |
| |
|
| Amerigroup Georgia (Managed
Medicaid) |
HMO |
| |
|
BeechStreet
BeechStreet Workers Compensation
Providian Health Advantage
|
PPO
WC
PPO
|
| |
|
BlueCross/BlueShield Health Plans
BlueChoice HealthCare Plan & BlueChoice Option
BlueCross/BlueShield
Prudent Buyer Program
|
HMO/POS
PPO
Managed Indemnity
|
| |
|
| Companion Workplace Health |
WC |
| |
|
|
Core Management Resources Group, Inc
(Clayton County Employees self-insured plan) |
PPO |
| |
|
| CIGNA HealthCare of Georgia, Inc. |
PPO/HMO/POS |
| |
|
| Coventry Health Care of Georgia, Inc. |
HMO/POS |
| |
|
| Evolution Health Plan |
PPO |
| |
|
| First Health (owned by Coventry) |
PPO |
| |
|
| First Medical Network (formally MRN) |
PPO |
| |
|
| Galaxy Health Network |
PPO |
| |
|
|
Great West Life |
HMO/POS/PPO |
| |
|
| Highway to Health |
PPO |
| |
|
Humana Military Healthcare Services
TriCare Prime
TriCare Extra
TriCare Standard (CHAMPUS)
|
HMO
PPO
Indemnity
|
| |
|
Humana Health Care Plans of Georgia, Inc.
Humana Medicare Advantage
|
HMO/POS/PPO
PPO
|
| |
|
Kaiser Health Plan
Kaiser Medicare
|
HMO
HMO
|
| |
|
MultiPlan
BCE Emergis/Pro America
Preferred Plan of Georgia |
PPO
PPO
EOP/PPO |
| |
|
| NovaNet |
PPO |
| |
|
| Peach State Health Plan (Managed Medicaid) (Centene) |
HMO |
| |
|
| Private HealthCare Systems, Inc.(PHCS) |
EPO/PPO |
| |
|
| SRMC Employee Benefit Plan ASO (administered by
Coventry) |
HMO/POS |
| |
|
| SouthCare PPO (Coventry) |
PPO |
| |
|
| United HealthCare Choice |
HMO |
| United Options |
POS |
| United Select Plus |
PPO |
| |
|
| USA Health Network |
PPO |
| USA Health Network Workman's Compensation |
WC |
| |
|
| Wellcare of Georgia (Managed Medicaid) |
HMO |
Managed Care 101 - Answers to
common questions about Managed Care
What is Managed Care?
Managed care describes a form of health insurance that relies on
a network of physicians and hospitals brought together to provide
medical services at a predetermined, reduced cost. Under managed
care, medical care is "managed" to meet both quality and cost
standards.
How Managed Care Benefits You
Managed care differs from the traditional healthcare indemnity insurance
that has covered consumers for over 50 years. Indemnity plans provide
coverage for members only when they require physician or hospital services.
With managed care, the emphasis shifts from the treatment of illness
to wellness, detection, and prevention.
Under most managed care plans, medical services such as
well-baby care, immunizations, mammography, other cancer
screenings, and physicals are routinely covered. These
preventive healthcare services are typically not covered by
traditional insurance plans. Managed care is proactive--instead
of reactive--healthcare.
Education is a priority. Managed care patients may be offered
classes prior to surgical procedures to ease and speed their
recovery. Educational opportunities may also include classes on
CPR training, prepared childbirth, stress and weight management,
smoking cessation, men's and women's health issues, allergies, and
diabetes.
How Managed Care Works to Contain Medical Costs
With health services provided in the most appropriate settings,
managed care results in decreased hospital admissions, shorter
lengths of stay, fewer inpatient procedures, and a reduction in
reimbursement per episode of care. This means that hospitals have
to economize and become more efficient. Nationwide, this has led to
the integration of hospitals into larger healthcare delivery
systems to share resources and reduce unnecessary duplications
of services.
Types of Managed Care Plans
Health Maintenance Organization (HMO)
This type of managed care plan charges a fixed fee to members in
exchange for comprehensive healthcare services. Preventive care
(such as physicals, immunizations, and cancer screenings),
hospitalization, and emergency care services are usually all
included. Members may only use the physicians and hospitals that
have been approved by the HMO. Hospitalizations must be approved
in advance. Generally, because of the reduced physician choice,
HMOs represent the lowest cost healthcare plan.
Preferred Provider Organization (PPO)
This managed care plan offers the use of a "preferred" network of
physicians and hospitals. Patients are allowed to go outside the
network for care, but they must pay the difference between the
preferred physician's discount fee and the higher fee of a
non-preferred physician. These plans do not emphasize
"health management" by a primary care physician. They often cost
more in insurance premiums than HMO or POS plans.
Point of Service Plan (POS)
This managed care plan combines features of an HMO and PPO. It
provides a comprehensive set of health benefits and allows health
plan members to use out-of-network providers, but with a reduced
level of benefits. Generally speaking, because it offers a wide
choice of physicians, this type of managed care plan also has
greater out-of-pocket costs than an HMO plan, but less than a PPO
plan.
Before You Choose a Plan
Before choosing a plan, ask yourself some key questions to
identify the plan that will work best for you and your family:
- Which plans cover the services you need most, such as
routine exams, specialty care, alternative healthcare, vision
and dental care, etc.?
- What services are excluded by the plans? Will your special
needs be covered?
- If your current doctor is not part of the managed care
plan, will you have to change doctors to join? Are the
providers conveniently located?
- How does the plan provide for services outside your local
area?
What is a Primary Care Physician (PCP)?
Another change under managed care is the rising influence of
primary care physicians. Today, your primary care
physician--family practitioner, internist, or pediatrician--is
assuming the role of "health manager." He/she knows your
complete medical history and treats the majority of your medical
needs. Your primary care physician also guides you when diagnostic
procedures and referrals to specialists are needed.
Choice of physicians is an issue in managed care plans. Most managed
care plans will furnish you with a list of approved or preferred
primary care physicians from which to choose. If your current
physician is not on the list, you will need to select a new
physician. Some plans allow patients to use physicians who are not
preferred providers; however, the patient then pays the difference
in cost. Thus, it becomes important to research the network of
primary care physicians, specialists, and hospitals that are
included in a plan before enrolling.
With managed care, many medical offices are now using physician
extenders such as certified nurse-midwives, physician assistants,
and nurse practitioners. These healthcare professionals provide more
patient teaching and preventive services, enabling physicians to
concentrate on more complex problems while others manage routine
care.
Managed Care Terms and Definitions
Capitation - A method of reimbursement where providers
receive a fixed per-member/per-month premium for each member
covered by that provider, regardless of how many or few
services the members use. In return for this payment,
the provider agrees to deliver a set program of healthcare
services to plan members.
Co-payment - A flat payment (often $10 to $20) made by a
plan member to a physician or other provider for services.
Fee-for-Service - The patient is charged according to a
fee schedule set by the provider for each service and/or
procedure provided.
Gatekeeper - Usually refers to the primary care physician
in a managed care plan who coordinates the care of the patient and
makes referrals to medical specialists.
Indemnity Insurance - The typical insurance plan of the past
20 years that provides physician and hospital benefits. Most
indemnity insurance pays 80 percent of the usual and customary rates.
Managed Care Plan - A health plan with a defined network of
providers cooperating to manage the care of each enrollee. Such
plans "manage" care by controlling the selection and use of services
and providers. Examples include PPOs, HMOs, and POS plans.
Personal Physician - Another term for primary care physician.
Physician Hospital Organization (PHO) - A legal entity formed
by a hospital and a group of physicians to negotiate and obtain
payer contracts.
Primary Care Physician (PCP) - Includes family practitioners,
general practitioners, internists, and pediatricians who provide
basic, routine, and preventive healthcare.
Providers - Individuals and institutions who are licensed to
provide healthcare services. Includes hospitals, physicians,
pharmacists, therapists, skilled nursing facilities, home health
agencies, etc.