The following statement is our Financial Policy as it pertains to patients.  It is required that the patient and/or responsible party read this statement prior to any treatment.  All patients and/or responsible parties must also complete and sign our Information and Insurance Form prior to treatment.

Self Pay

Payment in full is expected at the time of service. Payment arrangements must be made prior to service with the Business Office.                             We accept cash, checks. Discover, Visa, or MasterCard.

Insurance

We reserve the right to accept or deny assignment of insurance benefits; if we accept assignment of benefits it is your responsibility to supply our office with a copy of your current insurance card. Please remember that your insurance policy is a contract between only you and your insurance company. The balance on your account is your responsibility. In the event we do accept assignment of benefits and your insurance company has not paid your account in full within 60 days, you will be expected to pay your balance. Please keep in mind that some, and perhaps all of the services provided may be non-covered services. Also be aware that some services may not be considered reasonable and/or necessary under the Medicare Program or other medical insurance.   If we are a participating provider, all co-pays and deductibles are due at time of service. In the event that your Insurance coverage changes to a plan where we do not participate, please refer to the information in the above paragraph.

Medicaid

It is your responsibility to supply us with a copy of your current card at the time of service.  In the case emergencies we must receive this Information within 24 hours of service.   The patient is responsible for the full/entire balance if the information is not received. We accept Indiana Medicaid cards only. If you are an out-of-state Medicaid recipient, you may make arrangements with the Business Office to set up a payment schedule.

Worker's Compensation

Your employer must complete and sign a written authorization/incident report form. It is your responsibility to bring this completed form with you along with all billing information for your account (carrier name and address, contact person, telephone number and claim number if applicable). This information must be provided to us prior to treatment. If your account is not paid in full within 60 days, you are responsible and will be expected to pay your unpaid balance.  Monroe Hospital will not accept a delay in payment due to a worker's compensation dispute and/or litigation.  We may accept assignment of your health Insurance benefits.

Liability Injury

If you are being seen due to a liability injury, you must provide the following Information for billing and verification of payment prior to treatment:

*Auto Accident:  If you were injured in your own car, you must provide us with the name and address of your claim number and date of accident. If your injury occurred In someone else's car, we require all of the above information "and" the following, their name, the name and address of their auto insurance company, their agent/adjuster's name, telephone number and their claim number.

Veterans Administration Benefits:   VA Benefits are not considered an insurance.   Insurance such as Blue  Cross,  Medicare or any commercial insurance must be billed.  There may be co-pays associated that the patient will be responsible for paying.    

* Slip and fall. Other accidents, Etc: if you were injured on residential property or in a residential dwelling, we require the following:

Homeowner’s name, the name and address of their homeowner's insurance company, their agent/adjuster's name. telephone number, their claim number and the date of accident. If your injury occurred at a place of business, please provide basically the same information.

If your account is not paid in full within 60 days, you are responsible and will be expected to pay your unpaid balance. Monroe Hospital will not accept a delay in payment due to settlement disputes and/or litigation. We may accept assignment of your health insurance benefits only after your liability insurance has been paid/denied.

Minor Patients

The parent/guardian accompanying a minor is responsible for payment of the minor's account balance, A minor who is not accompanied by a parent/guardian will be denied any non-emergency treatment unless charges for the treatment have been pre-authorized.  Consent of parents or guardian is unnecessary if the medical treatment is for infectious, contagious, or communicable disease.

Assignment of Benefits and Release of Records

You do hereby assign Monroe Hospital, the medical benefits to which you, or your dependents are entitled, You also authorize Monroe Hospital to furnish to your health insurance company all your patient information including but not limited to any and all medical records, notes, test results, x-ray reports, MRI reports or other documents related to your treatment (including itemization of any charges and payments on your account) that is deemed necessary to process this claim, You also authorize Monroe Hospital to release any and all patient Information and medical records necessary to collect this debt.

Collection Costs and Procedures

If your account becomes delinquent, you agree to pay any additional charges to collect your unpaid bills, Including but not limited to, reasonable attorney fees, court costs and collection agency fees, By signing this policy, you do acknowledge that we reserve the right to release any patient information and any medical records to our collection agency deemed necessary to assist their staff and their attorneys in the collection of this debt.