Medical billing can be a complicated and confusing subject. Understanding what is covered by insurance, how much you’ll pay out of pocket, and how to work with insurance companies isn’t always easy. We know it can be frustrating to deal with medical bills, and we want the cost of the care you receive at WMCHealth to fair, clear, and with as few surprises as possible. We also want patients who do not have the ability to pay to receive the care they need. Here are important things to know about insurance and billing at WMCHealth.
Insurance Companies We Work With
WMCHealth is a participating provider in many health plan networks, including:
- Aetna
- Aetna Transplant
- Affinity/Molina
- Anthem/Empire Blue Cross
- Carelon Behavioral Health
- CDPHP
- Cigna Health and Life
- CignaLifeSource
- Dentaquest
- Emblem/GHI/HIP
- Empire Health Plus
- Fidelis/Centene
- First Health
- Hamaspik Choice
- HealthFirst
- Magnacare
- MVP
- Optum Behavioral Health
- Optum Transplant
- Oxford
- Partners Health Plan
- The Empire Plan
- United Healthcare
- VNS Choice Health Plan
- Wellcare
- World Trade Center Health Plan
- Medicare (Traditional)
- Medicaid (FFS)
- Tricare
Please remember that some health plans use smaller networks, so please check to see if we participate in your plan. Your level of coverage will depend on your individual health plan. Call us at 914.493.5446 with any questions, and reach out to your health insurance provider to confirm coverage, payment structures, and copays. If you’re not insured, you might qualify for help paying for your hospital bills.
You can also learn about the accepted plans at each of our hospitals, in addition to the financial assistance programs that are available by location here:
Behavioral Health Center
Maria Fareri Children’s Hospital and Westchester Medical Center
Bon Secours Community Hospital
Good Samaritan Hospital and St. Anthony Community Hospital
Bon Secours Medical Group
HealthAlliance Hospital and Margaretville Hospital
MidHudson Regional Hospital
WMCHealth Physicians Advanced Physician Services
Charges for Physician Services
Physician services you may receive in the hospital are not included in the hospital’s charges. Doctors might not participate in the same health plans as the hospital, and they may bill for their services separately. Check with the physician arranging for your hospital services to identify any required services from other physicians.
WMCHealth contracts with Westchester Medical Center Advanced Physician Services, P.C., to provide anesthesiology, radiology, and pathology services at the hospital. You can contact WMCAPS directly to find out which health plans they participate in or if you have questions about a bill.
Westchester Medical Center Advanced Physician Services, P.C.
19 Bradhurst Avenue, Suite 3100N
Hawthorne, NY 10532
914.570.8745
How to Pay a Bill
Log in to the patient portal or our bill pay tool to submit payment for care received at WMCHealth. If you have questions about your financial responsibility, please visit the hospital’s location page where you received services. WMCHealth will share any available information about standard charges and how to submit for coverage.
Need Help Paying Your Bill?
Understanding the Lingo
Knowing the commonly used terms could help you better understand your insurance coverage, the billing process, and who to reach out to for help. Here is some of the common language used in billing and insurance.
- Coordination of Benefits (COB): COB determines who the primary payer of services is when you’re covered under two or more insurance companies. For example, you could have Medicare and a commercial insurance. COBs prevent duplicate payments. You will be asked to choose which insurance coverage you want to use when you’re admitted.
- Co-payment: A fee you pay for a specific service. It’s usually due at the time of service.
- Co-insurance: This is the portion of your medical expenses that you’re responsible for paying. For example, if your insurance covers 80% of a bill, the other 20% is your co-insurance, which you pay for.
- Deductible: This amount is what you owe each year before your insurance begins making payments.
- Explanation of Benefits (EOB): It’s important to know that these are not bills. An EOB shows the amount billed by your doctor or hospital, how much is covered by your insurance, and how much you owe. After you leave the hospital, you’ll get an EOB statement from your insurance provider. This will show the amount covered by your insurance and the amount you owe and will be billed for.
- Billing Process: Hospital bills include charges for your room, meals, 24-hour nursing care and medicines, X-rays and lab tests. Doctors, surgeons and specialists may bill separately from the hospital.
- Types of Coverage: WMCHealth works with many commercial insurance companies, as well as Medicare and Medicaid. We’ll work with your insurance plan to determine how your bill will be paid. Please take the time to look into the terms of your insurance coverage, since your plan may have special requirements.
- Medicare: If you have Medicare, you’ll complete a Medicare Secondary Payer (MSP) form at admission. This ensures that Medicare only pays for services not covered by other insurance you may have. If you have a second type of insurance, this usually covers Medicare deductibles. If you don’t have secondary insurance, you’ll need to pay these amounts yourself.
- Self-Pay Patients and Payment: This means you’re planning to pay your bills without help from Medicare or a commercial insurance provider. If that’s the case, you’ll get bills directly from the hospital. When the first bill arrives, call the hospital’s Financial Services Department at 914.493.2089 or 914.493.5449 to set up a payment plan.