If you have Medicare or Medicaid, your rate is based on a system called Diagnosis-Related Groups (DRG's). All other types of insurance, if applicable, are based on the hospital's charges or on negotiated discounts with your insurance company.
Your insurance company will automatically be billed on your behalf, provided you submitted the necessary information before you were admitted. Within 30 days, you will receive an itemized statement indicating the amount your insurance company has paid and, if applicable, the remaining balance to be paid by you.
Please keep in mind that you will receive separate statements for each date of service. For instance, you will also receive separate bills for use of the hospital facilities in addition to the professional service fee of the physician. Other tests that may be billed separately include x-rays, laboratory, cardiology and consulting physicians; such services are provided by independent physicians who are not employees of the hospital.
You have the right to receive all the hospital care that is necessary for the proper diagnosis and treatment of your illness or injury. According to federal law, your discharge date must be determined solely by your medical needs - not by DRG's or Medicare payments.
You will be asked to sign a "Consent for Appeal" form prior to services being rendered. This will enable St. Joseph's Healthcare System to appeal the insurer's decision regarding reimbursement.
For additional information, questions or concerns, please contact your social worker/case manager:
St. Joseph's Regional Medical Center and St. Joseph's Children's Hospital: 973.754.3155
St. Joseph's Wayne Hospital, a division of St. Joseph's Regional Medical Center: 973.956.3707
Because we understand that hospital bills can be confusing, we assign a Patient Financial Representative to answer your questions, and iron out any difficulties. The representative who will handle your account will meet with you during the Pre-Admission Testing process, or shortly after you are admitted. He or she will discuss arrangements for paying your bill and will be glad to answer any questions you may have about charges, your insurance coverage, or payment.
If you need financial assistance, your Patient Financial Representative will explain possible public-assistance programs or credit arrangements. Financial arrangements are to be made prior to any "elective" (non-emergency) admission.
For additional information or to contact your patient account representative, please contact:
Monday - Friday: 8 a.m. to 5 p.m.
Notice for Patients and Physicians
Managed Care Update
St. Joseph's Healthcare System will remain in-network with Cigna.
Horizon Blue Cross Blue Shield (HBCBS)
St. Joseph's understands your concern. We have been negotiating with Horizon since June to reach an acceptable
HBCBS members are still in-network at St. Joseph's through December 31, 2013. This negotiation process involves
Horizon's Commercial and Medicare lines and therefore does not impact Horizon NJ Health (Medicaid).
You can always come to St. Joseph's Pediatric, Adult and Geriatric Emergency Departments for emergency care and
Horizon is required to pay for it, regardless of the outcome from these negotiations, before and after January 1, 2014.
The ads and letters that Horizon is sending out are misleading and can be intimidating. Please realize, Horizon cannot
stop you from choosing treatment at St. Joseph's, now or in the future.
St. Joseph's is asking Horizon for reasonable and necessary reimbursement rates in line with those offered to similar
Northern New Jersey hospitals. Horizon is the largest insurance company in the state with very large profits, and can
afford to provide St. Joseph's with fair rates.
If your enrollment period ends soon, we suggest that you change your coverage to a St. Joseph's in-network carrier. Please
refer to the "Managed Care Contracts" list posted on our website, www.StJosephsHealth.org. Search keyword "Financial
St. Joseph's accepts all patients regardless of insurance coverage.
St. Joseph's understands your concerns. You can always come to St. Joseph's Pediatric, Adult and Geriatric Emergency
Departments for emergency care and United is required to pay for it, regardless of coverage.
As always, St. Joseph's accepts all patients regardless of insurance coverage.
St. Joseph's will always stand by our patients. We are no longer in-network with United, but it is important to note:
• FOR EMERGENCY CARE, any UnitedHealthcare/Oxford Networks or Community Plan member can always come to a
St. Joseph's emergency room. UnitedHealthcare is required to pay for these services as if the patient had remained
• FOR NON-EMERGENCY OR ELECTIVE SERVICES, UnitedHealthcare/Oxford Networks members can still come to
St. Joseph's facilities. On admission, St. Joseph's will only collect the in-network deductible or co-payment amount on the
patient's insurance card. St. Joseph's will pursue full payment from UnitedHealthcare, and the UnitedHealthcare/Oxford
Networks member's responsibility will be no more than if the patient were in-network.
• Medigap benefits provided by UnitedHealthcare/Oxford Networks, as secondary coverage to Medicare, is not affected by
this contract termination and benefits provided by these policies will continue to be covered.