Premier Insurance Frequently Asked Questions 

Understanding your health insurance coverage is very important. Insurance plans can vary greatly in the amount of coverage they provide. Contact your insurance company to learn about your coverage and the benefits you are entitled to receive.

Receiving services from non-contracted or out-of-network providers often increases your costs for care. See if your insurance plan is contracted with our hospitals.

Learn more about insurance for Fidelity Health Care and how it helps to pay for care.

Learn more about Premier Physician Network billing and insurance.

What benefits am I entitled to under my coverage?

For questions about coverage, contact your insurance company before you receive services.

Many insurance plans require prior approval for care. Some physicians and hospitals help you get prior approval. While insurance may approve services, it may not pay because of policy limits. Contact your insurance provider for more information about policy limits.

Does the procedure/test I am scheduled for require prior authorization and if so, who is responsible for obtaining it?

Ask your physician if you need to get involved with the prior authorization process.

Does my coverage contain any policy limits or reduction in coverage if I choose to use a non-contracted (out-of-network) provider?

Read your policy or call your insurance company to determine if policy limits or reduction in coverage exists.

Fee estimates

Our hospitals provide patients with price information for common clinical services. The estimates are based on average charges for the particular service and your individual insurance coverage benefits.

Fee estimates are based on information you provide. To receive an estimate, you will need to get detailed information about your upcoming service(s) and procedure codes to prepare for billing.

What are procedure codes and where do I get them?

Procedure codes (CPT codes) describe services. Your health care provider will provide the codes.

Your fee estimate is based on procedure codes and includes descriptions of services and the estimated out-of-pocket expense.

Is my fee estimate going to be my total cost?

Not necessarily. A fee estimate includes costs for services requested. In some cases, a doctor or health care professional may need to perform additional services during the procedure, so additional charges are incurred. For example, during a routine colonoscopy your doctor may detect a polyp. The polyp is removed and sent to a lab for testing.

Do fees vary for a procedure?

Where a procedure is performed (doctor’s office, surgery center, hospital) may affect the total cost.

Payment

Often, a patient’s insurance may require payment for part of the services. In addition, some patients may have a deductible that must be met before the insurance plan begins to make payment on a patient’s services.

Be prepared to make a co-payment or down payment on your coinsurance amount during pre-registration or registration. You may be asked to pay in full for non-covered services before care is provided.

Hospital providers submit claims to your primary insurance (and secondary insurance when applicable), including Medicare and Medicaid. You will receive a bill telling you the amount you owe after the insurance pays its portion. The amount you are responsible for paying is listed in the AMOUNT DUE box. The balance is due when your statement is received.

For your convenience, payments can be made with cash, check or money order. We also accept Visa, MasterCard, Discover and American Express. You can also make payments online.

How much will my insurance pay?

Coverage and/or payment depend on your policy at the time of service. Review your benefit handbook or contact your insurance company to determine your coverage level for co-payment, coinsurance and deductible amounts.

What is my responsibility after insurance pays?

You are responsible for paying the remaining balance after your insurance company pays its portion. Please remember that if you receive services from an out-of-network provider, you may be responsible for a higher percentage, if not all, of the charges incurred. We strongly encourage you to contact your insurance provider before receiving services to verify your coverage.