Lakeland is here to meet your healthcare needs and assist you in making payment arrangements for our services. Please read this information carefully and feel free to ask any questions, we’re here to help. Lakeland is a not-for-profit system of care that provides emergency care for patients regardless of their ability to pay. For all non-emergent and elective treatments, tests and procedures, we request that you make arrangement for payment before or at the time of service.
Billing Philosophy
As a not-for-profit community hospital, Lakeland HealthCare strives to keep its charges as low as possible. It seeks to collect a sufficient amount of money to maintain stable medical services in the community. To that end, Lakeland HealthCare has established reasonable guidelines for payment which are designed to be as fair as possible.
Billing Policy
It is important that you contact your insurance company to determine and initiate any precertification requirements.
We will file your insurance claim with your primary and secondary insurance companies or managed care organizations if we are provided with all the required information and authorization. We will also assist you by sending requested information to your insurer. However, the responsibility remains yours to ensure that Lakeland Hospitals are paid for services rendered to you. You are ultimately responsible for any unpaid balances.
If your insurance company or managed care organization does not remit payment within 30 days, we may request that you contact your insurer to determine why payment has not been made. If an error has been made in identifying your insurance carrier, please notify us immediately.
Payment Policy
Payment in full is required at the time of service for all uninsured patients and those with co-pays, coinsurance, or that have not met their annual deductible on elective admissions and non-emergency outpatient services. Balances not paid by insurance are your responsibility.
In meeting your financial obligations for the care provided at Lakeland HealthCare, we ask that you work with us on any bills you are having difficulty paying. You will find our staff understanding and eager to help you.
If you don't have medical insurance
We request payment at the time of service or satisfactory payment arrangements made prior to service. If you are unable to pay for non-emergent services and do not have insurance, the service or treatment may be deferred until acceptable payment arrangements can be made.
Medicaid Eligibility
Lakeland has contracted with CareAssist, an Eligibility Service company, to help our patients who qualify for Medicaid coverage. This assistance is provided at no charge to the patient.
If you don’t have medical insurance
We request payment at the time of service or that you make payment arrangements with us prior to your surgery. If you are unable to pay for non-emergent services and do not have insurance, the service or treatment may be deferred until acceptable payment arrangements can be made. If you have any questions about your account balance, Please call our patient accounts customer service department between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday at 1-866-8147275.
Charity/Free Care
Qualifications
1. Residency - The applicant must be a resident of Berrien, Cass or Van Buren counties, and he/she must be a citizen or permanent resident of the United States. An exception will be made for patients who are receiving services related to an emergent accident that did not involve a motor vehicle.
2. Financial - The Lakeland HealthCare financial counselor or patient accounts representative will provide the initial screening if a patient is unable to pay for services rendered. All efforts to establish the patient's ability to pay shall be determined prior to providing the service where possible, the exception being emergency services where medical care is provided within federal EMTALA guidelines.
All patients will be offered the opportunity to apply for charity care; however, there is a minimum account balance of $100.00. The Lakeland HealthCare financial counselor or patient accounts representative will complete a Charity Screening Form when it is determined that a patient is uninsured and that they will not meet the qualifications for Medicaid. All accounts that do not qualify for Medicaid will be verified through the automated tool of choice by Lakeland HealthCare to verify income, household size, and Federal Poverty Level (FPL) for household income (see attachment A.) Lakeland HealthCare will utilize the current FPL & asset information to determine the amount of potential uncompensated care an applicant may be awarded. The applicant's assets may not exceed the Medicaid accepted level with the following exception: The patient may have up to $100,000 in a retirement account, I.R.A., T.S.A., or 401K.
Based upon the information collected from or with the automated tool of choice, each patient may be asked to complete a full charity application to be considered for full or partial uncompensated care. Applicants will be counseled on the criteria for eligibility and their responsibilities for completing the application, including providing supporting documentation for income and expenses. In the event that a full charity application is completed, the financial counselor will request copies of documentation deemed necessary to verify the information provided by the applicant, such as recent tax returns, W-2's, 1099's, bank and/or investment statements, and a current credit bureau report. Completed applications must be returned to Patient Accounts within 15 working days from the date of receipt to be considered. For the purposes of this policy, a completed application is defined as one that is signed and dated by the applicant, submitted within the above time frame, and is accompanied by the requested financial documentation.
3. Medical Necessity - Services considered will be those considered by Medicare to be a covered service. This shall not include any procedures that are considered to be cosmetic in nature, bariatric surgeries, circumcision, inpatient rehabilitation, and/or elective procedures. The Charity Care Committee reserves the right to recommend alternative care.
4. Participation - If at anytime during the process the patient is uncooperative in providing the necessary information to qualify for Medicaid or charity care, the application process will end, and any balance(s) shall be considered private pay.
5. Eligibility Period - The charity care eligibility period is 6 months from the date of the original eligibility determination, unless over the course of that 6 month period, the patient's family income, asset levels, or insurance status changes to such an extent that the patient becomes ineligible.
6. Collection Agency - All resources available will be utilized in determining charity care. However, if a collection agency identifies a patient as meeting the charity care eligibility criteria, the patient account may be considered for charity care, even if the account was originally classified as bad debt. These accounts shall be returned to Patient Accounts for appropriate disposition.
APPEALS
Appeals must be received, in writing, within 15 calendar days of the date of the denial letter. Once the appeal is received in the Patient Accounts office, the patient will be notified of the upcoming appeal hearing date. The hearing date will be no less than 15 days from the date the patient is notified. Exceptions to the charity care policy may be granted at the discretion of the CCC. Additional cases may be offered as charity care on an exception basis and would require the approval of the CCC.
EXCEPTIONS
Exceptions to the Lakeland HealthCare charity care application process:
- Patients or guarantors who are deceased with no estate in probate for whom no one else (such as a spouse or legal guardian) is legally responsible for the liability.
- Patients or guarantors who have declared bankruptcy with documentation that lists Lakeland HealthCare as a creditor.
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Accounts returned by the collection agency as uncollectible due to either of the above reasons.
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Exceptions to the charity care policy may be granted at the discretion of the CCC.
TIME REQUIREMENTS FOR CHARITY DETERMINATION
While it is desirable to determine the amount of charity for which a patient is eligible as close to the time of service as possible, there is no rigid limit in the time frame for charity determination. In some cases eligibility is readily apparent and a determination can be made before, on, or after the date of service. In other cases, a more thorough investigation may be necessary to determine eligibility.
CATASTROPHIC CHARITY
Catastrophic protection will be provided to low income patients by limiting their liability to 25% of their annual household income. If the total balance of the account(s) is greater than 30% of the annual household income, the patient will only be responsible to pay 25% of the total annual income. The remaining balance will be allocated to charity.
STATE-FUNDED PROGRAMS
Patients with a coverage from a Medicaid program who have accounts with private pay
balances that are not Medicaid deductibles will be awarded charity care for those
balances if the services were of an urgent or emergent nature, or prior approval was
granted by the Supervisor of Patient Accounts or Charity Care Committee (CCC). A
charity application will not be required in these circumstances.
If you have any questions about your account balance, please call Patient Accounts Customer Service between the hours of 8:00 a.m. and 5:00 p.m, Monday through Friday at 1-866-8147275.
Physician Bills
You may also receive separate bills from one or more physician’s offices. These bills may cover such expenses as physician services and/or professional interpretation of tests and X-rays. Questions concerning such bills should be directed to the office of the physician who sent the bill.
Payment Options
Payment in Full
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In person at any facility cashier (cash, personal check, credit card, travelers check, or money order)
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By telephone at 800-420-1472 (credit card, electronic check)
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By mail to: P.O. Box 410, St. Joseph, MI 49085 (personal check, credit card, travelers check, or money order)
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Online (credit card, online check)
Lakeland Hospitals are In-Network for the following:
Government Programs
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Medicaid
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Medicaid HMOs
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CareSource
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Health Plan of Michigan
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Medicare
Provider Networks
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Community Health Alliance (CHA)
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Elkhart Medical Organization (EMO)
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Indiana Health Network (IHN)
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Lakeland Care
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Private Healthcare Systems (PHCS)
Insurance Plans
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Aetna
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Blue Care Network
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Blue Cross Blue Shield of Michigan
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Cigna
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Humana
Participation is subject to change. Please verify with your insurance.
Our financial counselors are available to discuss other payment resources that may be available or to help you apply for medical assistance. For more information, call the financial counselors at the location you will be having surgery.
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Lakeland Hospital, Niles - 269-687-1417
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Lakeland Specialty Hospital, Berrien Center - 269-471-3271
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Lakeland Hospital, St. Joseph or Lakeland Center for Outpatient Services
Patients whose last names begin with A-G 269-983-8320
Patients whose last names begin with H-O 269-985-4589
Patients whose last names begin with P-Z 269-983-8241
Payment Address
Lakeland Hospital
P.O. Box 410
St. Joseph, MI 49085
