Hospital bills and health insurance claims can be confusing. We want to help you understand how we bill patients, and give you information on financial assistance.
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Hegg Health Center has a financial assistance policy if you meet certain requirements and are unable to pay your bill.
- Financial Assistance and Billing Practices
- Financial Assistance and Billing Practices – Español
- Summary of Financial Assistance
- Summary of Financial Assistance – Español
How to Request Assistance
- Contact the clinic or hospital business office at the phone number listed on your bill.
- Complete the Avera Financial Assistance Application (English)(Español) in its entirety.
- Return application with the following to your clinic or hospital to review:
- Most recent copy or your tax return, including all applicable schedules (balance sheet if agriculture/business).
- If your tax return is not available, then we need one of the following:
- Social Security award letter
- Proof of non-filing from the IRS (call 800-829-1040 to obtain a copy)
- Copies of earnings, pay stubs and bank statements for the last two months.
Providers and groups not subject to this policy that may treat Hegg Health Center patients (last updated 09/01/21)
Avera E Care Hospitalist
Avera North Central Heart
William Jongewaard, MD Sanford Sheldon General Surgery/OB/GYN
Avera Pulmonary & Sleep Medicine
Avera Medical Group Orthopedics
Nicolas Mouw, MD, Sioux Center Health Clinic, General Surgery/OB/GYN
Brian Dix, DPM, Avera Medical Group Orthopedics and Specialty Clinic, Podiatry
Elden Rand, MD, North Central Health Division of Avera
Dayna Groskreutz, MD Avera Medical Group Pulmonary & Sleep Medicine
Avera Medical Group Infectious Disease Specialist
Rural Emergency Medical Providers, LLC
Daniel Crawley, MD Osceola Regional Health Center, General Surgery
William Wosick, MD Radiology
Integrated Telehealth Physicarity
Patient Bill of Rights
Patient Bill of Rights
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.
Certain services at an in-network hospital or ambulatory surgical center
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.
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.
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 directly.
- Your health plan generally must:
- Cover emergency services without requiring you to get approval for services in advance (prior authorization).
- Cover emergency services by out-of-network providers.
- 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 benefits.
- Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact the Department of Health and Human Services at 1-800-985-3059. Iowa residents may contact the Iowa Insurance Division at 1-515-654-6600 or https://iid.iowa.gov/insurance-consumer-complaint.
Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
Right to Good Faith Estimates
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 1 business day before your medical service or item. You can also ask your health care 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.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
In an era of increasing health care costs and consumer-driven financing alternatives, the need for pricing transparency in health care services has taken on increasing importance. The goal of pricing transparency is to provide useful information about our health care facilities on a comparative basis across the various services provided.
Hegg is committed to providing pricing transparency. If you have questions about hospital pricing, please contact our business office.
Release of Information
Release of Information
If you have any questions regarding your hospital charges, payment options, financial assistance
program or your insurance, please contact our business office at (712) 476-8130.