If you have insurance coverage, proceed to the Overview of Insurance Billing section.

If you do not have insurance coverage, proceed to the Overview of Self-Pay Billing section.

Overview of Insurance Billing

Each insurance policy is different. If you are covered by health insurance, one of several scenarios will apply:

• Schuyler Hospital accepts your insurance and the service(s) you seek are covered by your policy.
• Schuyler Hospital accepts your insurance, but some or all of the service(s) you seek are not covered by your policy.
• Schuyler Hospital does not accept your insurance.

• • Insurance Plans with which Schuyler Hospital participates
  • Insurance Plans with which Schuyler Hospital does not participate (see Hospital Disclosure for Out of Network Law below)

We suggest that you discuss coverage with your private insurance carrier (or your employer if your coverage is employer-based) before you seek treatment, both to make certain you are insured and to learn how much of your treatment is liable to be covered by your policy. Schuyler Hospital will bill your insurance carrier directly, as long as you have provided complete billing information at registration/admissions.

**Note that if you are seeking medical treatment for a work-related injury, Schuyler Hospital will need Workers’ Compensation policy information for your place of employment in order to properly register and bill the account. We cannot bill your healthcare insurance policy for an injury sustained at your place of work.

**Note that if you are seeking medical treatment for injuries sustained during operations of a motor-vehicle, Schuyler Hospital will need No Fault policy information in order to properly register and bill the account. We cannot bill your healthcare insurance policy for an injury sustained during a motor vehicle incident.

Even if your insurance is accepted by Schuyler Hospital, and your plan provides coverage for the service/(s) you seek, you may still have a portion of the balance that is your responsibility – known as the “patient responsibility” portion of the claim. There are three different forms of patient responsibility that are common among insurance plans:

Copay – a flat fee amount per visit or per unit of service (e.g. $50 for Emergency Department visit) that insurance policies require the insured party to pay at the time of service. If your insurance requires copay for a given service, that payment is required upon registration.

Coinsurance – a percentage-based amount of the approved charges for a service that insurance policies require the insured party to pay. Since these amounts are percentage-based amounts of approved charges, they are not known at the time of service, and therefore will be billed after the fact for patient payment. Coinsurance is a method by which insurance companies and insured parties share the cost of services, and is one way of lowering the cost of insurance policy premiums.

Deductible – a minimum amount that insurance policies require the insured party to pay before the insurance company will pay anything toward charges for healthcare services. Usually, deductible amounts are reactivated yearly. Once the deductible has been met, then insurance coverage will pay for services rendered during the year. Since deductible amounts are patient-specific, they are not known at the time of service, and therefore will be billed after the fact for patient payment.

Your insurance coverage is a contract between you and your insurance company and, while we will assist you in expediting your claim, you are ultimately responsible for your account. Any amount not paid or adjudicated by your insurance plan is your responsibility. We accept cash, personal checks and most major credit cards (American Express, Discover, Visa, & MasterCard).

Financial Assistance and Payment Plans

If you receive a bill for an after-insurance patient responsibility amount, and you need assistance in meeting these financial obligations, please call our Financial Counselors to discuss your options. You may qualify for our Financial Assistance Program ,or you may be able to set up an interest-free payment plan to handle the balances owed.

Key Insurance Billing Terms:

Prior Authorization

Some insurance companies require that they be contacted prior to or within 24 hours of medical services being rendered (i.e. hospital admission, emergency services, outpatient procedures such as MRIs, physical and occupational therapy, and outpatient surgery). Schuyler Hospital appreciates every effort you make to inform us when your insurance policy will require pre-authorization for a service rendered.

Referral

A referral is a recommendation from your primary care doctor to see a certain specialist or receive certain services. Referrals are sometimes required before an insurance company will pay for treatment. Some specialists will only see patients who have obtained a referral.

Medicare Advanced Beneficiary Notice (ABN)

An Advanced Beneficiary Notice (ABN) is a form advising you that tests performed may not be covered by Medicare or your Medicare Advantage plan. The purpose of the Advanced Beneficiary Notice is to let you know in advance that these services may not be covered and to advise you that you will be responsible for payment of the charges if you choose to still receive the testing.

Approved / Allowed Amount

Insurers set pricing for medical services through contracts with each individual hospital/physician provider. Therefore, if you are covered under an insurance plan, the charges or prices for your services are dictated by your health insurance plan. This amount is known as the Approved / Allowed Amount, and the difference between Schuyler Hospital’s posted price and the insurance plans approved/allowed amount is not reimbursed. You may be responsible for a portion of the Approved / Allowed Amount, depending on your individual plan and if you are subject to patient responsibility copay, coinsurance or deductible amounts.

Birthday Rule

The Birthday Rule is called upon to determine which parent’s insurance plan is considered the primary plan for dependent children. According to the Birthday Rule, the primary plan will be the plan of the parent whose date of birth (month and day) falls earlier in the calendar year.

For example, if the father’s birthdate is March 4 and the mother’s birth date is January 22, the mother’s plan would be primary. If both parents have the same birth date, the primary health plan would be the one that has been in effect for the longer period of time.

The Birthday Rule is endorsed by the National Association of Insurance Commissioners (NAIC).

Overview of Self-Pay Billing 

If you do not have healthcare insurance coverage, we encourage you to contact our Financial Counselors to discuss options for handling healthcare expenses.

They are available to take calls Monday through Friday from 7:30 – 4:30 PM.

(607) 535-8639 x52321 or (607) 535-8639 x52356

Depending on your situation, you may qualify for Medicaid or individual insurance coverage (in some cases with financial discounts available) through the New York State of Health marketplace. Our financial counselors can connect you with Navigators who can work through the website application process with you to determine if any of these options are right for you.

After investigating insurance coverage options available, if you still find that your healthcare expenses are posing a financial hardship, Schuyler Hospital offers a Financial Assistance Policy, in conjunction with Cayuga Health System. Schuyler Hospital will reduce or eliminate patient financial responsibility for necessary and appropriate treatment and prevention in situations where the individual requiring treatment qualifies under financial hardship guidelines. Determination of financial hardship is based upon the income and assets available directly to the patient (applicant), or indirectly available through a parent or legal guardian. Schuyler Hospital uses the most current Federal Poverty Income Guidelines as a basis for these determinations. Each applicant for assistance must complete a written application and provide any information that is reasonably necessary to verify financial information.

Financial Assistance Application

View our Financial Aid Policy

Plain Language Summary of Financial Assistance Program 

View our Financial Aid brochure

View our Provider List

Schuyler Hospital, Cayuga Medical Center, and Cayuga Medical Associates all participate in Cayuga Health System’s Financial Assistance Program. One application will qualify you for financial assistance at any of the participating entities.

Charge Description Master and Pricing

If, after discussing with our Financial Counselors, you determine that you do not qualify for Medicaid, NY State of Health marketplace plans, or the CHS Financial Assistance Program, and you truly are purely a Self-Pay patient and you know what service(s) you need, you can review Schuyler Hospital and Schuyler Employed Physician charge description master and pricing here.

The Charge Description Master (CDM) is the database that shows all potential chargeable services and items that may appear on a hospital or physician bill. These charges only apply to Self-Pay patients who have no insurance coverage at all, and who do not qualify for Financial Assistance. For these patients, we do offer a Prompt-Pay Discount to assist with the cost of services. The associated discount is 50% for accounts paid within 30 days of receipt of the first statement, and is shown on the CDM file for comparison.

New York State assesses a HCRA Surcharge (tax) for purely self-pay hospital services of 9.63%. The surcharge impact to CDM line item pricing is also indicated on the CDM file for comparison. Note that the HCRA surcharge does not apply to physician services.

Each individual’s healthcare needs are unique, and directed by your physician. You may find it difficult to determine on the CDM file what services you may need. Our Financial Counselors are available to help provide pricing estimates. Pricing provided is always considered an estimate until final coding and documentation of your visit/services is completed, since pricing may vary based on pre-existing health conditions, severity of illness, length of stay, actual procedures performed, lab testing required, and drugs/supplies utilized.

Financial Counselors are available to take calls Monday through Friday from 7:30 – 4:30 PM.

Connie (607) 535-8639 x52321

 Charge Description Master – Field Explanation

The Charge Description Master file is in .csv format, and will open using Microsoft Excel for viewing and searching purposes. The fields in the file are defined below:

Indicator – tells whether the line item is a hospital (Hosp) or physician (Phys) charge

Department – tells in which department the service is provided

Mnemonic – unique identifier of the charge code

Description – written description of the item/service (contains abbreviations)

-GLBL – “global” combined physician charge for office-based locations
-P – “physician-only” charge; when added to associated hospital charge equals GLBL charge
-LT – left side
-RT – right side
-BI / BIL – bilateral
-TX – treatment
-FX – fracture
-CL or CLSD – closed
-BX – biopsy
-DX – diagnostic
-VFC – vaccines for children
-INJ – injection
-IM – intra-muscular
-IV – intra-venous
-W/ – with
-W/O – without
-EXC – excision
-US – ultrasound
-MRI – magnetic resonance imaging
-CT – computed tomography
-F/U – follow-up
-WBC – white blood cell
-RBC – red blood cell
-GI – gastro-intestinal
-R&B – room and board
-I&D – incision and drainage
-MX – multiple

CPT Code – 5 digit code representing the procedure performed; extra 2 or 4 digits appended represent modifiers that alter the meaning of the CPT code

**Note – CPT Codes are copyrighted by the American Medical Association

HCPCS Code – 5 digit code representing the procedure performed (populated if Medicare requires a separate/unique code to report the service); extra 2 or 4 digits appended represent modifiers that alter the meaning of the HCPCS code

**Note – HCPCS Codes are copyrighted by the American Medical Association 

Price – current price for the line item/service

Price + Surcharge – current price for the line item/service with the NYS HCRA 9.63% surcharge applied

*Note – HCRA surcharge only applies to hospital line items, not to physician line items.

(Price + Surcharge)-Prompt Pay Discount – current price for the line item/service with the NYS HCRA 9.63% surcharge applied, and the 50% prompt pay discount applied (valid for payment in full within 30 days of first statement)

Units – used for certain pharmaceutical products, shows how many billing units are included in the line item price shown; if blank, assume 1

Notes – explanatory information

Pricing

Schuyler Hospital strives to price our items/services in a defensible manner, which is reflective of our cost to provide healthcare services to our patients. We take into account standard Medicare reimbursement amounts for each item/service when setting our prices, and are always looking to remain competitive with similar services that are provided in our local market area whenever possible.

Supplies and pharmaceuticals are priced based on current acquisition cost plus a markup factor. Prices for these items are subject to change on a regular basis, and the CDM file will note the date of validity for pricing shown. Schuyler Hospital will work to update the CDM file on the website periodically to reflect updates, and at minimum, will do so annually.

If you have a question or concern regarding pricing of any items/services within our charge description master file, please contact our Financial Counselors