Although finances may be the last thing on your mind at a time like this, having an understanding of how the system works can make your visits to the Cancer Center go more smoothly. St. Vincent's Comprehensive Cancer Center and our physicians accept most insurance plans. Please check with your physician's office for information about your insurance plan.
As a new patient, you may want to contact your insurance provider for a written copy of your insurance policy. Having this information can help you make informed decisions about your care and assist us in getting the information we need to process your insurance claims quickly and accurately. To avoid delays in handling your claims, please notify your doctor's medical secretary or the Cancer Center's registration office of any change in your insurance and/or demographic information.
Know the Rules of Your Insurance Plan
Here are some things you should know regarding your health insurance upon visiting the Cancer Center for the first time.
Primary and Secondary Insurance Coverage
If you are covered by more than one insurance program, we will need information
about both to coordinate your benefits. Remember to carry all of your insurance
identification cards with you when coming for your healthcare visit.
Managed Care Plans - HMO, PPO or POS
Managed care plans often require you to use specific physicians, facilities and/or
ancillary services. They frequently require you to pay co-payments and obtain referrals from your Primary Care Physician before receiving healthcare services.
Co-Payments
Some insurance plans have per visit co-payments, annual deductibles or lifetime or
annual limits. Separate co-payments may be required for your doctor or professional
services and for technical services such as laboratory tests, x-rays, radiation treatments or
chemotherapy. If any portion of your bill is payable at the time of service, you will be able to pay with cash, check or major credit card. All costs not covered by your insurance company are your responsibility.
The Role of Your Primary Care Physician (PCP)
The PCP often plays an important role in managing your care. He or she may issue referrals, suggest further tests and coordinate your care with your physician at the cancer center. Be sure to let your PCP know that you are coming to the Cancer Center.
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Referrals
A referral is a specific direction or instruction from your PCP, which directs you to a participating provider for medically necessary care. A referral can be issued as a paper document or electronically. Electronic referrals can be printed and may resemble a credit card slip. Most of the physicians at St. Vincent's Comprehensive Cancer Center are considered specialists and may require a referral from your PCP.
Some referrals allow for multiple visits, some for a single visit and others for a specified time period. Your insurance plan will have this information. You, as the patient, are responsible for obtaining additional referrals as required.
If your insurance plan is a Health Maintenance Organization (HMO), you are usually required to:
- Select and contact/visit your PCP to obtain written referrals for the cancer center and the cancer center physicians.
- Bring copies of your referrals when you come to the cancer center for your appointment.
- Obtain referrals for all scheduled follow-up procedures and physician visits as necessary.
- Check with your insurance carrier to make sure you understand how to manage your referrals.
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Pre-authorization from Your Insurance Company
Certain service and/or procedures require pre-authorization from your insurance company. A list of all service requiring preauthorization should be available from your insurance company. If a physician at the cancer center suggests a procedure that requires pre-authorization, the staff at the cancer center will work with your insurance company to obtain the necessary authorizations.
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Coverage for Clinical Trials
You and your doctor may determine that the best treatment is to participate in a clinical trial. Even if you have health insurance, your coverage may not include some or all of the patient care costs associated with a clinical trial. Call your insurance company to see if they will cover treatments which may be considered experimental or research studies.
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Financial Assistance
The cancer center has a financial counselor who can provide guidance to patients who are underinsured or who do not have insurance to cover their medical care. Staff is available to assist patients with applying for Medicaid.
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Understanding Your Bills
You will be receiving multiple bills for services received at the cancer center. You will receive bills for technical services including all tests and procedures performed at the cancer center and separate bills for any professional services rendered from each physician involved in your care.
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