The Patient Financial Services staff is available to respond to inquiries by phone regarding billing.
Via the phone, patients may request an itemized statement, pay their amount due with a checking account or credit card, set up a payment plan, and/or provide additional insurance information not given at the time of service.
In addition, our staff can provide some information related to the patient's insurance benefits and exclusions.
Q. What is the difference between a co-payment, co-insurance and deductible?
A. In most cases, health insurance carriers offer two major types of coverage; HMO plans or traditional plans. HMO plans generally set a fixed dollar amount for office visits, outpatient visits, emergency room visits and sometimes inpatient stays that the patient is required to pay directly to the provider at the time of service. This is called a co-payment.
Traditional plans and Medicare establish a fixed dollar amount that must be paid by the patient (usually annually) prior to any payment made by the health insurance carrier. This is called a deductible.
A co-insurance is typical with traditional plans and Medicare. The health insurance carrier pays a percentage of the charge and the remaining balance is the responsibility of the patient.
Q. Why was my health insurance carrier not billed?
A. There are times when Kaleida Health does not have adequate insurance information to generate a bill to the insurance carrier. In these cases, we have no alternative but to send a patient statement to the patient’s guarantor requesting additional information. When you register for medical services, it is very important that you provide all of the necessary information so that we are able to bill your insurance carrier for payment.
Q. What information is needed to bill my insurance carrier?
A. The following information is required:
- The name, address and phone number of your insurance carrier.
- The subscriber’s name on the policy.
- The identification number including any prefix and/or suffix.
- The effective date of the policy.
It is very helpful if you show the registration clerk or receptionist your health insurance identification card each time you come in for medical services. You may ask to have this information read back to you to ensure your record is accurate.
Q. Why did it take so long for me to receive a bill?
A. It is a practice of Kaleida Health not to bill a patient until we have exhausted all means of obtaining payment from your health insurance carrier. At times, we receive partial payments or denials that we feel are incorrect. Therefore, we must follow the appeal process established by your health insurance carrier to dispute their decision. These processes can result in a delay in billing you for your portion of the bill.
Q. How can I obtain a detailed or itemized statement?
A. Simply call our customer service department at (716) 859-7200 Monday through Friday between the hours of 8:30 a.m. and 4:30 p.m. and our representatives will be happy to mail you one.
Q. Can I pay my co-payment or balance by credit card?
A. All of the Kaleida Health sites accept Visa, MasterCard, American Express and Discover. You may charge any payment utilizing one of these credit cards. We can also take this information over the phone if it is inconvenient for you to come to a cashier window in person, or you can pay online.
Q. What if I want to pay without using my insurance?
A. Please call the Self-Pay Quote line at 859-8900. The team provides quotes for patients who would be paying all costs out of pocket, without using insurance. You will leave your name, phone number and the CPT codes for the services you are inquiring about and a team member will get back to you within 48 hours. CPT codes are billing codes used identifying the services; these CPT codes can be provided to you by your referring physician.
Q. What if I don't have insurance?
A. If you do not have insurance and would like to speak with a financial counselor regarding options, please call 859-8979 read more about our Financial Assistance Program. One of our facilitated enrollers will be able to assist you with the options available.
Q. What if I am using my insurance and would like a quote regarding the amount I will have to pay after insurance pays their portion (patient responsibility)?
A. Please contact your health insurance company directly. They will have access to your specific insurance coverage and will be able to give you the most accurate estimate of what you will be responsible to pay.
Q. What insurance plans does Kaleida Health participate with?
A. Kaleida Health, as a hospital system, participates with several insurances, as listed below.
There are often several different plans and/or allowed services offered by an insurance carrier, and Kaleida Health may participate with only certain plans. While we have tried to list the most common plans, if you have any questions, do not see your plan listed, or would like more information, we welcome your call at (716) 859-CARE.
Health Insurance Plans That Participate with Kaleida Health Hospitals and Employed Physicians
Although Kaleida Health participates with most insurance companies, we may be excluded or limited in our participation of certain product plans offered by an insurance company. Please contact your insurance company directly to determine if your specific product plan participates with Kaleida Health.
| Insurance Company | Insurance Product | Kaleida Health Participates with Insurance Product | Hospital Employed Physicians Participates with Insurance Product Employed Physicians List (pdf) |
|
Aetna |
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| Commercial/Self Funded | Kaleida Health participates through Magnacare | Physicians participate through Magnacare | ||
| Medicare | Yes | Yes | ||
| Medicaid | No | No | ||
Amerigroup |
||||
| Child Health Plus | Yes | Yes | ||
| Medicaid | Yes | Yes | ||
Beacon Health Strategies |
||||
| Commercial/Self Funded | Yes | Yes | ||
| Child Health Plus | Yes | Yes | ||
| Essential Plans | Yes | Yes | ||
| HARP | Yes | Yes | ||
| Health Benefit Exchange/Metal Tier | Yes | Yes | ||
| Medicaid | Yes | Yes | ||
Beech Street |
||||
| Commercial/Self Funded | No | No | ||
Blue Cross Blue Shield of Western New York (Medicare, Medicaid, Commercial, Healthcare Exchange)
|
||||
| Commercial/Self Funded | Yes | Yes | ||
| Essential Plans | Yes | Yes | ||
| Health Benefit Exchange/Metal Tier | Yes | Yes | ||
| Medicare | Yes | Yes | ||
| Medicaid | Yes | Yes | ||
Cancer Services of Erie County |
||||
| Yes | Yes | |||
Cancer Services of Niagara County |
||||
| Yes | Yes | |||
Catholic Health LIFE |
||||
| Program All Inclusive Care Elderly (PACE) | No | No | ||
Centers Plan for Healthy Living |
||||
| Managed Long Term Care | Yes | No | ||
| Medicare | No | No | ||
| Fully Integrated Dual Eligible (FIDA) | No | No | ||
| Special Needs Plan (SNP) | Kaleida Health participates through Magnacare | Physicians participate through Magnacare | ||
Cigna |
||||
| Commercial/Self Funded | Kaleida Health participates through MVP | Physicians participate through MVP | ||
| Medicare | Yes | Yes | ||
Coventry |
||||
| Commercial/Self Funded | Yes | Yes | ||
| Medicare | Yes | Yes | ||
| No Fault | Yes | Yes | ||
| Workers Compensation | Yes | Yes | ||
Department of Veterans Affairs - Patient-Centered Community Care Provider Network |
||||
| Yes | No | |||
Emblem Health/GHI |
||||
| Commercial/Self Funded | Yes | No | ||
| Medicare | Yes | No | ||
| Medicaid | No | No | ||
| Essential Plans | No | No | ||
Empire Blue Cross Blue Shield |
||||
| Commercial/Self Funded | Yes | Yes | ||
| Medicare | Yes | Yes | ||
Fallon Health |
||||
| Managed Long Term Care | HighPointe on Michigan only | No | ||
| Program All Inclusive Care Elderly (PACE) | Yes | Yes | ||
| Special Needs Plan (SNP) | Yes | Yes | ||
Fidelis |
||||
| Medicaid | Yes | Yes | ||
| Medicare | Yes | Yes | ||
| Health Benefit Exchange | Yes | Yes | ||
| Dual Advantage | Yes | Yes | ||
| Fully Integrated Dual Eligible (FIDA) | Yes | Yes | ||
| Managed Long Term Care | Yes | Yes | ||
| Health and Recovery Plan (HARP) | Yes | Yes | ||
| Essential Plan | Yes | Yes | ||
| Child Health Plus | Yes | Yes | ||
First Choice Health |
||||
| Commercial/Self Funded | No | No | ||
First Health |
||||
| Commercial/Self Funded | Yes | No | ||
KALOS Health |
||||
| Managed Long Term Care | Yes | No | ||
Healthnet Federal |
||||
| Tricare | Yes | Yes | ||
HealthPlex |
||||
| Medicaid | Yes | No | ||
Hospice Erie and Niagara |
||||
| Hospice | Yes | Yes | ||
Humana/Choice Care |
||||
| Commercial | Yes | No | ||
| Medicare | No | No | ||
Independent Health |
||||
| Commercial/Self Funded | Yes | Yes | ||
| First Choice | No | No | ||
| Health Benefit Exchange | Yes | Yes | ||
| Medicare | Yes | Yes | ||
| Medicaid | Yes | Yes | ||
| Essential Plans | Yes | Yes | ||
| Child Health Plus | Yes | Yes | ||
Indian Health Services - Tuscarora |
||||
| Inpatient Services Only | Yes | No | ||
Lifetime Benefit Solutions (EBS-RMSCO) |
||||
| Commercial/Self Funded | Yes | Yes | ||
Magnacare |
||||
| Commercial/Self Funded | Yes | Yes | ||
Martin's Point Healthcare (Tricare) |
||||
| Tricare | Yes | Yes | ||
Medicare |
||||
| Traditional Medicare (Part A and Part B) | Yes | Yes | ||
Medicaid |
||||
| Traditional Medicaid | Yes | Yes | ||
Meritain |
||||
| Commercial/Self Funded | Kaleida Health participates through Magnacare and Multiplan | Physicians participate through Magnacare and Multiplan | ||
Multiplan |
||||
| Commercial/Self Funded | Yes | Yes | ||
MVP |
||||
| Commercial/Self Funded | Yes | Yes | ||
| HARP | Yes | No | ||
| Health Benefit Exchange/Metal Tier | Yes | Yes | ||
| Medicare | Yes | Yes | ||
| Medicaid | Yes | Yes | ||
| Essential Plans | Yes | No | ||
NOVA |
||||
| Commercial/Self Funded | Yes | Yes | ||
Oscar Insurance Corporation |
||||
| Health Benefit Exchange/Metal Tier | Kaleida Health participates through Magnacare | Physicians participate through Magnacare | ||
POMCO |
||||
| Commercial/Self Funded | Kaleida Health participates through Magnacare | Physicians participate through Magnacare | ||
| Workers Compensation | Kaleida Health participates through PHCS | Kaleida Health participates through PHCS | ||
United Healthcare |
||||
| Commercial/Self Funded | Kaleida Health participates through Multiplan. | Yes | ||
| Commercial/Self Funded-Key Bank members only | Yes | Yes | ||
| Health Benefit Exchange/Metal Tier | No | No | ||
| Medicare | Yes | Yes | ||
| Medicaid | Yes | Yes | ||
| Dual Complete (Special Needs Plan) | Yes | Yes | ||
| Managed Long Term Care | Yes | Yes | ||
| Essential Plans | Yes | Yes | ||
Univera Healthcare |
||||
| Commercial/Self Funded | Yes | Yes | ||
| Health Benefit Exchange/Metal Tier | Yes | Yes | ||
| Medicare | Yes | Yes | ||
| Medicaid | Yes | Yes | ||
| Child Health Plus | Yes | Yes | ||
| HARP | Yes | Yes | ||
| Essential Plans | Yes | Yes | ||
Universal American/American Progressive |
||||
| Commercial/Self Funded | No | No | ||
| Health Benefit Exchange/Metal Tier | No | No | ||
| Medicare | Yes | Yes | ||
| Essential Plans | No | No | ||
Wellcare |
||||
| Medicare | Yes | Yes | ||
| Medicaid | Yes | Yes | ||
| Managed Long Term Care | Yes | Yes | ||
| Health Benefit Exchange/Metal Tier | No | No | ||
| Essential Plans | No | No | ||
| Fully Integrated Dual Eligible (FIDA) | No | No | ||
YourCare Health Plan |
||||
| Medicaid | Yes | Yes | ||
| Essential Plan | Yes | Yes | ||
| Child Health Plus | Yes | Yes | ||
Q. I have received an authorization, approval, or pre-certification from my insurance company for my upcoming hospital service. Does this mean that all other physician services, such as anesthesiologists, are automatically approved, as well?
A. No. It is possible for a hospital to participate with an insurance plan, but for a physician to not. You should check with your physician office(s) to determine their participation, or contact your insurance company with any questions.