Services

Patient Financial Services

The Patient Financial Services staff is available to respond to inquiries by phone regarding billing.

Via the phone, patients may request an itemized statement, pay their amount due with a checking account or credit card, set up a payment plan, and/or provide additional insurance information not given at the time of service.

In addition, our staff can provide some information related to the patient's insurance benefits and exclusions.

Q. What is the difference between a co-payment, co-insurance and deductible?

A. In most cases, health insurance carriers offer two major types of coverage; HMO plans or traditional plans. HMO plans generally set a fixed dollar amount for office visits, outpatient visits, emergency room visits and sometimes inpatient stays that the patient is required to pay directly to the provider at the time of service. This is called a co-payment.

Traditional plans and Medicare establish a fixed dollar amount that must be paid by the patient (usually annually) prior to any payment made by the health insurance carrier. This is called a deductible.

A co-insurance is typical with traditional plans and Medicare. The health insurance carrier pays a percentage of the charge and the remaining balance is the responsibility of the patient.

Q. Why was my health insurance carrier not billed?

A. There are times when Kaleida Health does not have adequate insurance information to generate a bill to the insurance carrier. In these cases, we have no alternative but to send a patient statement to the patient’s guarantor requesting additional information. When you register for medical services, it is very important that you provide all of the necessary information so that we are able to bill your insurance carrier for payment.

Q. What information is needed to bill my insurance carrier?

A. The following information is required:

• The name, address and phone number of your insurance carrier.
• The subscriber’s name on the policy.
• The identification number including any prefix and/or suffix.
• The effective date of the policy.

It is very helpful if you show the registration clerk or receptionist your health insurance identification card each time you come in for medical services. You may ask to have this information read back to you to ensure your record is accurate.

Q. Why did it take so long for me to receive a bill?

A. It is a practice of Kaleida Health not to bill a patient until we have exhausted all means of obtaining payment from your health insurance carrier. At times, we receive partial payments or denials that we feel are incorrect. Therefore, we must follow the appeal process established by your health insurance carrier to dispute their decision. These processes can result in a delay in billing you for your portion of the bill.

Q. How can I obtain a detailed or itemized statement?

A. Simply call our customer service department at (716) 859-7200 Monday through Friday between the hours of 8:30 a.m. and 4:30 p.m. and our representatives will be happy to mail you one.

Q. Can I pay my co-payment or balance by credit card?

A. All of the Kaleida Health sites accept Visa, MasterCard, American Express and Discover. You may charge any payment utilizing one of these credit cards. We can also take this information over the phone if it is inconvenient for you to come to a cashier window in person, or you can pay online.

Q. What if I want to pay without using my insurance?

A. Please call the Self-Pay Quote line at 859-8900. The team provides quotes for patients who would be paying all costs out of pocket, without using insurance. You will leave your name, phone number and the CPT codes for the services you are inquiring about and a team member will get back to you within 48 hours. CPT codes are billing codes used identifying the services; these CPT codes can be provided to you by your referring physician.

Q. What if I don't have insurance?

A. If you do not have insurance and would like to speak with a financial counselor regarding options, please call 859-8979 or click here. One of our facilitated enrollers will be able to assist you with the options available.

Q. What if I am using my insurance and would like a quote regarding the amount I will have to pay after insurance pays their portion (patient responsibility)?

A. Please contact your health insurance company directly. They will have access to your specific insurance coverage and will be able to give you the most accurate estimate of what you will be responsible to pay.

Q. What insurance plans does Kaleida Health participate with?

A. Kaleida Health, as a hospital system, participates with several insurances, as listed below.

There are often several different plans and/or allowed services offered by an insurance carrier, and Kaleida Health may participate with only certain plans. While we have tried to list the most common plans, if you have any questions, do not see your plan listed, or would like more information, we welcome your call at (716) 859-CARE.

Health Insurance Plans That Participate with Kaleida Health Hospitals and Employed Physicians

Although Kaleida Health participates with most insurance companies, we may be excluded or limited in our participation of certain product plans offered by an insurance company. Please contact your insurance company directly to determine if your specific product plan participates with Kaleida Health.

Q. Are there other physicians that are not employed by Kaleida Health that may provide care to me during my hospital stay?

A. Yes. Kaleida Health contracts with external physician groups to provide certain services in the hospital. Services provided by these providers are separate from your hospital stay, and you will receive a separate bill for their services. You may wish to contact the group office(s) to confirm participation with your insurance. Contact information for these groups is provided below.

Please note that other physicians, including those that may be asked to provide services or consultations for your care, are not employed or contracted with Kaleida Health, and may send you or your insurance company a separate bill. We encourage you to contact your insurance company should you have any questions regarding your coverage.

You should also check with the physician arranging for your Hospital services to determine if the services of any other physicians will be required for your care. Your physician can provide you with the practice name, mailing address and telephone number of those physicians whose services may be needed so you can determine what health care plans they participate with.

Q. I have received an authorization, approval, or pre-certification from my insurance company for my upcoming hospital service. Does this mean that all other physician services, such as anesthesiologists, are automatically approved, as well?

A. No. It is possible for a hospital to participate with an insurance plan, but for a physician to not. You should check with your physician office(s) to determine their participation, or contact your insurance company with any questions.