Understanding Insurance

Home Patient & Visitors Insurance Understanding Insurance

Under your health plan, you are responsible for certain cost-sharing amounts, including copayments, coinsurance and deductibles. You may have additional costs or be responsible for the entire bill if Confluence Health is not within your insurance plan’s network. This is often referred to as “surprise billing” or “balance billing.” However, in many scenarios you are protected by law from receiving a balance bill for your care.

If you have questions about your insurance, keep reading to see some answers to questions we receive from patients. You can also contact our Patient Financial Services Department at (509) 436-4020 or toll-free at (888) 499-4801.

Patient Financial Service staff are available from 8 a.m. to 5 p.m., Monday through Friday, at (509) 436-4020, or visit any of our in-person areas.

Insurance Information

Insurance Definitions

Precertification’s, Referrals and Authorizations

Insurance FAQs

You should contact your insurance company, see our In-Network Plans/Payers page or call our Patient Financial Services Department 509.436.4020 Hours: Mon-Fri, 8 a.m. to 5 p.m.

When a healthcare provider is “in-network” it means the insurance company will cover a higher percentage of the charges. When a provider is “out-of-network” you can still go to this provider, but you will be required to pay a larger percentage of the bill.

Yes, you are expected to pay your copayment when you arrive. Your insurance card should indicate the dollar amount of the copayment required for each type of service. If you have questions regarding copayment amounts, please contact your insurance company or your employer.

Yes, we will bill your insurance company for you, provided you have given us complete insurance information, including the name of the company, the address to which claims are to be billed, your policy identification number, your group number (if applicable), subscriber name and a phone number.

Health insurance policies vary widely on which procedures, services or items an insurance company will cover. In order to maximize your health insurance benefits, familiarize yourself with the policies and benefits outlined in your health insurance handbook or contact your health insurance customer service department for policy and benefit verification.

Questions to ask your insurance company:

  • Am I covered for (service/item name)?
  • What is my benefit maximum?
  • Do I need a prior authorization for (service/item name)?

If your claim has not been paid and you are receiving notices from Confluence Health, you should make a follow-up phone call to the insurance company.

If you believe your insurance company did not pay for your services properly, please call your insurance company first.

You have the right to appeal any decision made by your insurance company. Simply call the number on your insurance card or on the Explanation of Benefits provided by your insurance company. Your insurance company can advise you of its dispute procedures.

Many insurance companies have amounts which the patient must pay. These are called deductible, copay or coinsurance payments. If your insurance plan requires you to pay a deductible or coinsurance, the balance will be billed to you. If you have a question about why your insurance company did not pay part of a claim, you should call your health insurance company directly.

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

All providers at Confluence Health are participating providers with the Medicare Program. You are responsible for any deductibles and co-insurance portions.

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, preauthorization’s, 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.

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