Billing and Insurance Information
Southwell Patient Financial Services
Allow Us to Assist You
Representatives with Tift Regional Health Systems’s (TRHS) Patient Financial Services are available to help answer questions patients and family members may have about insurance coverage, deductibles, co-insurance and payment arrangements. They will be glad to explain your insurance benefits and requirements related to your TRHS bill; explain Medicare requirements; estimate your bill; assist with special payment arrangements; and refer you to a financial assistance program. If they cannot answer your question, they will direct you to someone who can.
Deductibles, non-covered services and co-insurance amounts may be paid before or at the time of the hospital stay.
If You Have Insurance
TRHS works with many insurance carriers. However, some insurance plans require you to go to a specific provider or network. Others require you to obtain pre-authorization. To avoid surprises, contact your insurance company to see what they require.
TRHS will bill the primary and secondary insurance carriers and provide additional information as needed to process your hospital claim. Once the insurance carrier pays its portion of the bill, or if the carrier denies payment of the bill, the balance of the account becomes your responsibility. Services provided by a physician will be billed separately from hospital charges by the physician’s billing service.
After Your Insurance Pays
You will receive a billing statement after payment by your insurance carrier. This statement will include total charges for services and any payments made by the insurance company. Other correspondence may be sent or calls made to help keep you informed of the account balance and any payment you are expected to make. To receive an itemized statement, please call (229) 353-6124 option 3 or e-mail by clicking here. To receive your itemized statement please include patient name, account number and date of birth.
Payments can be made at the Patient Financial Services office, Monday through Friday, 8:00 a.m. to 4:30 p.m., or by mail to the address below. Southwell accepts Mastercard, VISA, American Express and Discover credit cards. To utilize a credit card, present your card at the cashier’s window or return your credit card information by mail on the billing statement.
For correspondence please mail to:
To view our Chargemaster, please click here.
Need financial assistance? Please click here for information.
Your Rights and Protections Against Surprise Medical Bills
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 surprise billing or balance billing.
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, and/or a deductible. You may have other 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. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay 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 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.
You are protected from balance billing for:
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 and coinsurance). 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 balanced billed for these post-stabilization services.
The state of Georgia and the federal government both have laws to protect you from balance billing although they are a little different. State rules only apply to fully insured commercial health insurance plans and some government plans. Federal rules may also apply to commercial health insurance in situations where you received health care services in another state, your health insurance is regulated by a state other than Georgia or the health care service you received is not regulated by the state law. Most of the differences between the state and federal laws are in the way the rules affect providers and health insurers, so you usually won’t need to worry about that. However, the grievance processes are different, as indicated on the government websites linked below.
Certain services at an in-network hospital, ambulatory surgical center or other facility
When you get services from an in-network hospital or ambulatory surgical center, certain providers there 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. Under Georgia law this rule also applies to imaging centers, birthing centers, and similar facilities in addition to hospitals and ambulatory surgical centers. 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.
The best way to find an in-network provider is to use the online provider directory on your health plan’s website.
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 deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities
- Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization). Under Georgia law, your health plan cannot later deny such services because they don’t consider them medically necessary.
- Cover emergency services by out-of-network
- 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
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket
Your rights and protections against surprise medical bills
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
If you believe you’ve been wrongly billed, first contact your provider and/or your health plan for an explanation. If they can’t resolve your concerns, you can contact the Georgia Office of the Commissioner of Insurance and Safety Fire online at https://oci.georgia.gov/ or by phone at (404) 656-2070.
Visit https://www.cms.gov/nosurprises for more information about your rights under federal law.
Visit https://oci.georgia.gov/how-do-i-file-complaint for more information about your rights under Georgia law.