Health Insurance
UNC Health Lenoir will submit a claim to your insurance company based on the supplied, required information from you. You are responsible for any portion of charges not covered by your insurance and payment is expected at or prior to the time of service.
If you have not paid at the time of service, all amounts billed to you are payable upon receipt of the statement. Delayed insurance payments do not relieve patients of their obligation to pay the balance when due.
HMO, POS, or PPO Insurance
Patients with HMO, POS, or PPO coverage are responsible for paying any co-payment, deductibles, co-insurances, or fees for non-covered services at the time the services are rendered. Full payment of co-pays is requested before services are rendered.
To help you get the most from your health plan, UNC Health Lenoir encourages you to familiarize yourself with your insurance plan’s requirements prior to seeking care. Since your employers negotiate their own contracts with insurance companies, plans can differ significantly. Each patient has a responsibility to know and understand his or her individual benefit package. A common example is $150.00 co-pay that a number of UNC Health Lenoir contracted payers have for emergency room visits. Your plan may be higher or lower than our example.
If you have any questions regarding insurance payment or denial, please contact one of our Commercial Claims Analysts. If you have any questions regarding insurance for a Blue Cross Blue Shield plan please contact a Blue Cross Claims Analysts.
Additional Benefits & Insurance
Browse the information below for information about Medicaid, Medicare, Worker's Compensation and Accidents or Liability.
Medicaid
UNC Health Lenoir will submit claims to Medicaid, provided that you supply the required information and/or verification of coverage is obtained through the Department of Social Services.
You may be responsible for a portion of your charges if Medicaid makes that determination. If you do not have medical insurance or feel you may qualify for Medicaid, UNC Health Lenoir has a staff person on-site from the Lenoir County Department of Social Services to assist you with your Medicaid application.
Workers' Compensation
If services you are requesting are the result of a work-related injury, UNC Health Lenoir will bill your employer or your employer’s liability carrier. We will also ask for your health insurance information in the event that Worker’s Compensation denies the claim or does not cover all the charges.
Written authorizations are sometimes necessary. Due to insurance authorization requirements please have the Worker’s Compensation incident documented and approved by your employer before receiving services except in the event of an emergency.
Accidents & Liability
No one enjoys getting into accidents, or the hassle that comes along with settling liability claims. If an accident occurs, let us know and we will do the work for you. We will be glad to work directly with your liability insurance carrier and/or attorney to come to a satisfactory conclusion.
Medicare Benefits
“Medical Necessity” is a term that has been used in recent years by Medicare and may not be familiar to you. “Medical Necessity” means that there are procedures and services physicians may prescribe for you that they may feel are necessary to manage your health. However, Medicare may not pay for certain services based up on their policies.
In the past, Medicare has covered most procedures. With the emergence of MRI, CT Scan, and other sophisticated and costly services and procedures as the diagnostic methods of choice, it is important for you to know what procedures and services will be covered by asking your physicians and or Medicare. We also encourage you to discuss with your physicians other treatment options available to you that may give them the information that they need to treat you. If your physician orders a procedure or service that Medicare may not cover, you may be asked to sign an Advance Beneficiary Notice (ABN). The ABN informs you in advance that Medicare is not likely to pay for the procedure or service, and that you will be responsible for payment. By signing the ABN, you are indicating that you understand and agree to be personally and fully responsible for payment.
Medicare beneficiaries are responsible for deductibles and co-insurance. If you receive services as an outpatient or in outpatient observation, you will be billed for non-covered oral drugs and some injectable drugs that fall under the category of Self-Administered. Please refer to the online version of National Medicare Handbook at www.medicare.gov or call 1-800-633-4227 if you need more information.
Do You Have Any Options?
You can agree to be financially responsible for the procedure by signing the ABN form, or you can refuse the test or services. If you refuse the test or services, you will also be asked to sign a form indicating you’ve elected not to have the service.
If you request the services and will not sign the ABN, you will still be responsible for payment. If you need services that are not covered by Medicare, you will be responsible for payment. You have the right to appeal a Medicare decision not in your favor.
If you would like to appeal a Medicare decision, or have other Medicare questions, please contact the Medicare beneficiary hotline at 800-633-4227.
