All patients should familiarize themselves with the terms of their insurance coverage. This will help you understand the health system’s billing procedures and charges. If there is a question about your insurance coverage, a member of the Patient Access Department will contact you or a member of your family while you are here. Information is needed in order to process your claims.
If you have health insurance
We will need a copy of your identification card. We also may need the insurance forms, which are supplied by your employer or the insurance company. You will be asked to assign benefits from the insurance company directly to the health system.
If you are a HMO or PPO member
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 of your plan have been met. If your plan’s requirements are not followed, 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 be covered.
If you are covered by your auto insurance
Regardless of whose fault the nature of your visit is, Capital Health will need a copy of your automobile insurance card, or the card of the driver of the car you were in when you were in the accident. This should be supplied immediately to prevent you from getting any payment notices or having your account sent to a collection agency.
If you are covered by Medicare
We will need a copy of your Medicare card 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. Deductibles and co-payments also are the responsibility of the patient.
If you receive Medicare and you are admitted to one of our hospitals, you will receive a document called "An Important Message from Medicare." This briefly describes some of your rights as a Medicare patient. We are proud to be a participating Medicare provider.
If you are covered by Medicaid
We will need a copy of your Medicaid card. 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.
If you have no insurance
A health system representative who is a representative of the Division of Family Services is available to assist you in applying for Medicaid or other government assistance programs. Please call the Patient Accounting Department at ext. 6023 or dial directly at 609-394-6023 if you have been discharged and have not made any arrangements to resolve your account.
Click here to learn more about our Financial Assistance Policy/Program.
If you come into the emergency room without your insurance information
Please contact the Patient Accounting Department at ext. 6023 or dial directly at 609-394-6023 to supply them with your insurance information. This will prevent you from getting any bills for services.
Your bill for hospitalization
As a service to you, the health system will submit bills to your insurance company and will do everything possible to expedite your claim. But you should remember that your policy is a contract between you and your insurance company and you have the final responsibility for payment of your hospitalization bill. We have several payment options available to assist you in paying your bill.
Your bill reflects all of the services you receive during your stay. Charges fall into two categories – a basic daily rate, which includes your room, meals, nursing care, housekeeping, and charges for special services which include items your physician orders for you, such as X-rays or laboratory tests.
If you have certain tests or treatments in the hospital, you may receive bills from physicians you did not see in person. These bills are for professional services rendered by these doctors in diagnosing and interpreting test results while you were a patient. Pathologists, radiologists, cardiologists, anesthesiologists, and other specialists perform these services and are required to submit separate bills. If you have questions about these bills, please call the number printed on the statement you receive from them.
For more information
If, at any time before or during your hospitalization, you should receive a letter from your insurance company, or Capital Health’s Utilization Review, and you have questions or disagree with any decisions made, a representative from the Central Billing Office will be happy to answer your questions or assist you in appealing those decisions. Please contact us at ext. 6080 (Capital Health Regional Medical Center) or ext. 4286 (Capital Health Medical Center - Hopewell).
If you have any questions regarding your hospitalization bill, please call ext. 6023 or dial directly at 609-394-6023.
Your Rights and Protections Against Surprise Medical Bills
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When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn't be charged more than your plan's copayments, coinsurance and/or deductible.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, or a deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan's deductible or annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care — like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You are protected from balance billing for:
Emergency services
If you have an emergency medical condition and get emergency services from an out-of- network provider or facility, the most the provider or facility may bill you is your plan’s in- network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balance billed for these post-stabilization services.
According to the Out-Of-Network mandate signed by Governor Phil Murphy in 2018 (Out-of-Network Consumer Protection Transparency, Cost Containment and Accountability Act, P.I., 2018) protections are afforded to all patients with regards to surprise hospital billing in the state of New Jersey. Capital Health will not bill patients more than the patients' in-network cost share for emergency/inadvertent out-of-network services
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
Generally, your health plan must:
- Cover emergency services without requiring you to get approval for services in advance (also known as "prior authorization").
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you think you’ve been wrongly billed, contact the Centers for Medicare & Medicaid Services at 1-800-985-3059. Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law. Contact 1-800-792-9770 or visit www.nj.gov/health/healthfacilities for more information about your rights under New Jersey state law.
You have the right to receive a "Good Faith Estimate"
Under the law, health care providers need to give patients who don’t have certain types of health care
coverage or who are not using certain types of health care coverage an estimate of their bill for health
care items and services before those items or services are provided.
- You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- If you schedule a health care item or service at least three business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within one business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within three business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within three business days after you ask.
- If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email [email protected], or call 1-800-985-3059.