Will insurance pay for my care?
Insurance coverage varies among individual insurers and policies. Please call your insurance company before your visit to understand what they will pay, which providers and hospitals are in-network, and what you will need to pay out-of-pocket. It is your responsibility to provide Samaritan staff with your insurance coverage information and to notify them if your coverage changes. Bring your insurance and photo ID cards with you to your appointment.
Check if Samaritan is in your health plan’s network
Your health plan documents may describe what is covered when you get care “in-network” and “out-of-network.” The differences can be substantial.
- In-network: When Samaritan is “in-network,” it has negotiated a contract with rates for services it provides to you and other members of your health plan. Some insurance plans only pay for your services at in-network healthcare providers and facilities.
- Out-of-network: We don’t have a contract if Samaritan is “out-of-network” for your health plan. Some plans won’t pay any of the costs if Samaritan is not in their network or will pay lower percentages of billed charges.
While many major health insurance carriers have contracts with Samaritan, it’s important to note that not every plan offered by a contracted insurer covers services at Samaritan, so it’s a good idea to confirm.
If you need help, you can call your health plan or use its online directory of providers (often called “Find a doctor”).
Find out if your treatment needs prior approval.
Health plans often require approval for major services and treatments in advance. The health plan will not cover costs if certain treatments aren’t approved.
- Your doctor’s office will submit a request to approve treatment to your health plan. But it’s always wise to ask your doctor, “Will my health plan need to approve this first?” The health plan notifies you and your doctor of their decision.
Learn what your portion of costs may be.
Getting a cost estimate before a major service will help you prepare for and understand your bills. You can contact us for an estimate, use the cost estimator available on MyChart or use a cost estimator on your health plan’s website.
Billing and Insurance FAQs
Healthcare billing processes can be confusing and hard to navigate. We’ve addressed some of the most commonly asked questions here.
Samaritan has different types of healthcare practitioners who provide services to patients. For example, your x-rays may have been evaluated by a physician that you never personally met, and their name will appear for those services.
65 or older — Trained volunteers can also help you learn about Medicare plans in Washington through the Statewide Health Insurance Benefits Advisers program. You can reach a Washington SHIBA representative at 800-562-6900.
Or you can shop for plans at medicare.gov.
Charges that may not be paid by your insurance and may then become your responsibility include:
- Deductibles
- Co-insurance and/or co-pays
- Benefit limitations, i.e. items or services not covered under your insurance plan
- Medicare program exclusions (see your Medicare handbook for a complete listing).
Check your explanation of benefits and/or contact your insurance company with your specific questions.
Insurance claims may also be denied because of missing or incorrect subscriber information on the claim. If you believe your claim was denied for this reason, please call us immediately. Have your explanation of benefits in hand when you call. We will update your account and/or re-bill your insurance.
Please note that for third-party liability cases such as automobile accidents, the patient or his/her guarantor is responsible for payment. Samaritan will not hold open accounts until settlement is reached with a third-party payer.
You will be asked a series of questions required by law at each visit regarding your status, including other insurance you may have, and your retirement date. If you are covered by Medicare, we will submit your claims to Medicare on your behalf.
I received notice that you sent my account to a collection agency. Why didn’t you bill my insurance?
Please contact Patient Financial Services at 509-793-9715 Monday-Friday from 8:00 AM-5:00 PM for more information regarding your account. Your insurance may have been billed and this is the balance due after insurance (copay, coinsurance, deductible). Or we may require more information to bill your insurance.
As noted on your statements, your balance is due, in full, at the time of billing. Our billing system requires a formal payment plan to be entered to prevent a patient’s account from being referred to collections. Please contact Patient Financial Services at 509-793-9715 Monday-Friday from 8:00 AM-5:00 PM to discuss your options.