The Patient Financial Services Department at Calais Community Hospital is comprised of billing staff for hospital accounts, billing staff for physician office accounts, data processing, and the Patient Financial Services Director. The office is staffed Monday through Friday from 7:30 am until 4:30 pm and closed on holidays.
We will be happy to bill your insurance company directly for services provided. If you have more than one insurance, we will bill them for any balance after your primary insurance has paid. If we need additional information from you in order to bill your insurance, we will contact you for this information. Sometimes an insurance company requires its insured to provide them with information directly, and will not accept the information from the hospital, such as any details surrounding an accident you may have had. It is very important that you respond promptly to any requests you receive from your insurance company for information.
We will send you a monthly statement for each account you have at CCH that has a balance due from you. If you would like an itemized copy of your bill, you may call to request a copy or you can visit our secure online bill payment module that will allow you to pay a bill, update information, view a bill, make payment arrangements or apply for free/reduced care. Our payment module will accept credit card, debit card and online check payments.
Some physician interpretation fees are billed separately. Your physician and other physicians, with whom he or she consults with, may also send you separate bills for their services. Payments for these services should be sent directly to their offices and not to CCH.
If you have questions surrounding your bill, please contact our financial counselor at 207-454-9351.
Calais Community Hospital participates with Medicare, Maincare, Tricare, Cigna, Aetna, Anthem and many third party insurance companies. Some of those are Great West, United Healthcare, Harvard Pilgrim Healthcare, Patient Advocates, American Maritime Officers Benefit Plan, and American Postal Workers Union. Please feel free to contact us to inquire if CCH has an insurance agreement with your insurance company.
Price Estimates: Patients often find it helpful to know how much a procedure or test is going to cost before they have it done. If you would like to know the cost of a procedure or test, please call our Patient Financial Counselor at 207-454-9351.
For additional cost information please visit the Maine Health Data Organization’s Maine Health Website at: http://www.comparemaine.org/
The Patient Financial Services Director welcomes your questions, suggestions and comments and can be reached directly at 207-454-9211.
Frequently Asked Questions (click to expand):
This is a Medicare requirement. When a physician is part of a hospital/health care system (sometimes called Provider-Based or Hospital-Based Outpatient care), Medicare requires that the bill show separate charges for (1) physician care and procedures done in that office and (2) necessary facility charges for physician care.
Some lab tests are drawn in the physician office and then sent to the hospital or other facility for processing. The Hospital Outpatient Lab Charge is the cost of processing the test at the hospital.
If you spend the night at the hospital, it does not always mean that you are here as an inpatient. You may be here under observation, which is actually an outpatient service. Observation allows your doctor to monitor your condition to determine if you should be admitted to the hospital or allowed to return home. Although you may not require admission to the hospital, you may still require additional monitoring, diagnostic testing and medication before you are able to go home. The doctor has up to 48 hours of observation time to determine if you will need to be an inpatient.
During the course of any outpatient treatment, you may be given medication that is considered self-administered by Medicare. Medicare defines self-administered as medications that you could, in another setting, take yourself. The list of medications includes tablets, sprays, drops, inhalants and some injectable drugs. In order to remain compliant with Medicare regulations related to these drugs, hospitals are required to bill patients for these drugs. You will receive a bill from us following payment of our claim by Medicare. With few exceptions, most secondary insurances do not cover self-administered drugs.
Medicare has certain guidelines it sets in order for certain outpatient diagnostic tests to be covered by them for payment. When you present to register at the hospital for outpatient diagnostic testing, your services will be screened for medical necessity. If the diagnosis that your medical provider gives us does not meet their policy guidelines for payment, you will be asked to sign an ABN. The ABN will tell you the name of the test that is not covered, and the approximate cost of the test. The notice informs you that if you have the test, you will be responsible for paying for the test. Even though Medicare will not pay for the test, your physician believes that the test he has ordered will provide valuable information related to your continuing medical care. You may decide to have the test and pay for it, or you may decide to defer the test and have further discussion with your physician about obtaining a covered diagnosis, or alternate testing that may provide him/her with the same results.
Not all services you may require or request from CCH may be covered. These may include, but are not limited to:
- Dental services, such as when you come to the emergency room for a toothache or other dental pain
- Cosmetic surgery
- Routine or screening tests, except for those defined by Medicare as covered under preventative guidelines
- Routine pregnancy care
- Emergency room visits to have prescriptions refilled
- Eyeglasses, except for one pair following cataract surgery
- Lens implants at the time of cataract surgery that correct astigmatism or presbyopia
- Physical exams (routine or yearly).
- Medicare will cover a one-time physical exam as outlined in their “Welcome to Medicare” guidelines.
- Prescription drugs that are considered self-administered (see above)
- Certain immunizations to prevent illness, such as zoster (shingles) vaccine. Flu and pneumonia vaccines ARE Medicare covered vaccines.