Billing and Insurance Information
It is our goal at Confluence Health to provide quality health care in an efficient and cost-effective manner.
Medical information, including insurance policies change so rapidly, it is hard for anyone to keep up-to-date and well informed. We have provided this information to assist with some of the more frequently asked questions. Understanding your own co-pays and deductibles is essential for determining your out of pocket expense.
Confluence Health requires that all utilization-related decisions regarding member services be based on appropriateness of care and service. Financial rewards or incentives must not influence any utilization decision. No rewards or incentives are issued by Confluence Health that may discourage appropriate care and services to its patients/members. Under-utilization is to be avoided whenever possible.
We do not reward practitioners, providers or employees for issuing denials of coverage or service. All denials must be based strictly on insufficient medical appropriateness or not a covered benefit.
Insurance Plans Accepted at Confluence Health
• Asuris Northwest
• Community Health Plan of Washington (specialty care only)
• Coordinated Care
• First Choice Health Network
• Health Alliance Northwest
• Health Net Federal (TriCare)
• Molina Healthcare of Washington
• Premera Blue Cross
• Regence Blue Shield
• Uniform Medical Plan administered by Regence BlueShield
Since your plan coverage changes from time to time, please review your network status, insurance plan benefits, copays, annual deductible and coinsurance. Contact your insurance company to confirm that your care at Confluence Health will be covered. Your benefit plan may have specific networks that do not include Confluence Health.
Under your health plan, you’re responsible for certain cost-sharing amounts. This includes copayments, coinsurance and deductibles. You may have additional costs or be responsible for the entire bill if you insurance plan is not accepted at Confluence Health. This is often referred to as ‘surprise billing’ or ‘balance billing.’ In many scenarios, however, you are protected by law from receiving a balance bill for your care. Click this notice for details on your rights as a patient with regards to balance billing.
Frequently Asked Questions:
Which Insurance companies do you bill?
We accept and bill most major insurance plans. We ask that you show us a copy of your medical insurance card so we can set up the correct billing information. Our business office can provide you with the necessary information should you have questions about the billing of your specific insurance plan.
What does “contracted” insurance and “allowable” mean?
“Contracted” insurance means that we have agreed to accept that particular insurance company’s fee schedule for payment of our services. Allowable is another term used for this. Although we accept the insurance allowable, there is usually a portion, percentage, deductible or co-pay for which the patient has financial responsibility.
What happens if Confluence Health is not contracted with my insurance company?
If Confluence Health is not contracted with your primary insurance company, we will still bill your insurance as a courtesy to you. You will be financially responsible for any portion of your bill that your insurance company does not pay
What if I am injured on the job?
Confluence Health’s Occupational Health Department is available to treat your on-the-job injuries. You will need to complete an accident report. If your Washington-based employer is self-insured, your employer will provide you with the report and claim number. If your Washington-based employer is insured through the Washington State Department of Labor and Industries, you will be asked to complete a report at the time of your visit. Confluence Health will bill your on the job injury claims to the appropriate insurance carrier for you. If the insurer approves your claim, you will not be responsible for any work injury related charges.
What if I am injured in a motor vehicle accident?
If you seek treatment for motor vehicle related accidents, Confluence Health will send a notice offering to bill your motor vehicle insurance company for you. We provide this service as a courtesy to you. You will be responsible for any portion not paid by your automobile insurance carrier.
Do you accept Medicare Assignment?
All providers at Confluence Health are participating providers with the Medicare Program. You are responsible for any deductibles and co-insurance portions.
When is payment from the patient due?
We do expect payment at the time of service. If we are on contract with an insurance company, the patient’s portion of our fee, co-pay or deductible is due at the time of service. We accept cash, check, Visa, MasterCard, and Discover as payment options.
Do you take monthly payments or set up payment plans?
If you are financially unable to make full payment at the time of service, our business office can set up a payment plan. You should request this option as early as possible, preferably on the first visit. If you feel you are not able to comply with our payment plan, you may apply for an extended payment plan which requires the completion of a personal financial statement. Based on your financial statement, it is possible that we will be able to forgive a portion (or all) of your bill. Having all patients apply in this same manner enables us to treat all of our patients fairly.
What if I am in the middle of a lawsuit?
A lawsuit is an action taken by you against another party and does not involve us. Therefore, we cannot wait for settlement or judgement to be paid. You are responsible for your account, not the third party.
Who is responsible for payment and follow-up with the insurance company?
If you are 18 or over, you are legally responsible for your own account, regardless of who you live with, who has the contract with the insurance company or who claims you as a tax deduction. If the patient is under 18, BOTH parents, despite divorce or other separating agreements, or the legal guardian are responsible for payments.
We ask that you be fully responsible for knowing the specifics of your particular insurance contract. Examples of these specifics include co-pays, deductibles, second opinions, preauthorizations, preferred providers, covered and non-covered services and preferred hospitals. Our office is staffed to request preauthorization from your insurer for your hospital and/or surgical visit. This does NOT guarantee payment. Payment will be made according to YOUR contract.
Confluence Health cannot accept the responsibility for collecting your insurance reimbursement or negotiating a settlement on a disputed claim. We can provide you with the necessary medical information to assist you.
When will I receive a statement?
Statements are created based on your Confluence Health activity. You will receive a monthly statement for those months when you have an outstanding balance or there are transactions posted to your account. At the time transactions are posted to your account, if we are contracted with your insurance company, you will also receive a notice of insurance billed. This notice will tell you which insurance was billed, when it was billed, and the service that was billed. Please contact our business office in the event that any information on this notice is incorrect.
If you have any questions about our credit policy or your bills, please contact our business office and we will be happy to assist you.
Pay Your Bill Online
An easy and secure way to pay your bill. Please have your billing statement in front of you.
If you have questions about your bill or making payments, please contact our Patient Services Department at (509) 436-4020 or toll-free at (888) 499-4801.
For specific questions about our Charity Care Program, please email us at firstname.lastname@example.org.