Insurance + Billing

A GUIDE TO YOUR HOSPITAL BILL

Our goal at Pagosa Springs Medical Center Patient Financial Services is to provide you with an accurate, timely and easy to understand hospital and/or clinic bill.  We hope that the following information will help you in fully understanding your bill.

Insurance

We are a participating provider for most insurance plans.  We will submit a claim to your insurance company.  Claim processing usually takes 30-45 days.  Soon after that time you should receive an Explanation of Benefits (EOB) from your insurance company explaining how your claim was processed and if there is any amount that you must pay, usually deductibles, co-payments, and/or co-insurance. You will receive a bill from the hospital once we have received payment from your insurance company.  We extend a prompt-pay discount of 5% on the amount you owe us if paid in full within 30 days of your first statement. Your insurance coverage is between you and your insurance company and it is your responsibility to know what your insurance benefits include.

Medicaid

We have staff available who can speak with you about the possibility of applying for Medicaid.  To speak with a financial counselor about applying for Medicaid, please call (970) 585-1405.

Medicare

Medicare will only pay for services that it determines to be “reasonable and necessary”.  If Medicare determines that a particular service, although it would otherwise be covered, is “not reasonable and necessary” under the Medicare program standards, Medicare will deny payment for that service.  Prior to the service being provided, you will be asked to sign an Advance Beneficiary Notice (ABN), which identifies services that may not be covered and for which you may be personally responsible.

Veterans

We participate in the Veterans Community Care Program.  All non-emergent services must be prior authorized by the Veterans Choice Program.  Emergent and inpatient services require notification to the Veterans Choice Program within 72 hours.  This notification will determine if the service is authorized at Pagosa Springs Medical Center or if the Veteran will need to be transferred to the closest Veterans facility.  Our Rural Health Clinic serves as an approved Urgent Care for the Veteran program.We honor all Veterans programs.

If You Do Not Have Health Insurance

If you do not have insurance, you may be asked for a deposit before services are provided.  We will bill you shortly after the services are rendered.  We extend a 15% discount from billed charges to all uninsured patients.  If the balance is paid in full within 30 days of your first statement, an additional 15% discount will be applied.  If you wish to make payment arrangements, please contact our Patient Financial Services Department at (970) 585-1405.

Charity Care/Financial Assistance

This program is designed to assist patients who are either financially or medically indigent but do not qualify for Medicaid.  To apply for assistance through this program contact our Patient Financial Services Department at (970) 585-1405.

Auto Accident Patients

If you have been in a motor vehicle accident, please provide the following information:

  • Name and address of auto insurance carrier
  • Adjustor name and phone number
  • Claim number

It is our policy to pursue liability insurance as primary payment for services rendered to you.  If you have health insurance it will be billed once the auto insurance has been exhausted.

Other Bills You May Receive

The bill you receive from Pagosa Springs Medical Center will only contain charges for services provided by the hospital, hospital employed physicians and the Clinic.

Physicians not employed by the hospital will bill separately for their services. You may also receive a bill from:

Radiology ▪ Radiology Imaging Associates (303) 643-4500

Pathology ▪ Cedar Diagnostics (970) 565-8482

Contact Information

The Patient Financial Services Department is available to assist you with any questions you may have concerning your hospital bill.

Office Hours

Monday-Friday

8:00 a.m. to 4:30 p.m.

95 S. Pagosa Blvd.

Pagosa Springs, CO  81147

Telephone 970-585-1405   FAX 970-731-1889

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