Patient Financial Services

Below you will find useful information to ensure the timely and accurate processing of your medical claim for services you received at our facility. We take pride in the proper handling of all insurance claims and we will do everything possible to ensure that you are satisfied with our efforts and the outcome. We want to ensure that you maintain a positive impression of our facility throughout your care and the billing process. A member of the Patient Accounting team is available to you during our normal hours 8:00 a.m. to 4:30  p.m. Monday – Friday. During this time, we will accept walk-ins at the Patient Financial Services building located on the eastern end of the hospital or we can simply speak with you over the phone to remedy any issues or concerns. To accommodate your busy schedule, we are happy to meet you after hours by appointment.

If you have any questions regarding your bill please contact our Patient Account Helpline at (407) 498-3737. Due to the high volume of inbound and outbound calls we are not always able to answer your call as we desire. Feel free to leave a message including your name, contact information, and account number. Any calls received prior to 2pm will be returned on the same business day; calls received after 2:00 p.m. will be returned the next business day. You may also contact us through our patient accounting helpline email: scrmc.patientbilling@hma.com.

Explanation of our billing cycle

Our billing cycle varies depending on the type of insurance you carry, but all claims go through a mandatory series of tests prior to billing your insurance to ensure the accuracy of the medical information and charges present on the record. This testing period generally takes 2 to 4 days following your discharge date. After this period your claim will be billed electronically (if available) to your specific insurance company. The claim will typically be received and identifiable in the payor system within 3 days of billing for claims submitted electronically and approximately 7-10 days for mailed hard copy claim forms. Florida Statue 627.613 (1) dictates that an insurance company must make payment on a clean claim within 30 days of receipt of said claim or inform us in writing to explain any delays, denials, or non-covered services. During the billing period many patients will receive statements to keep you informed about the status of the claim billed to your insurance. The different categories are as follows:

Commercial insurance plans

(including Blue Cross, Aetna, Cigna, United Healthcare, Tricare, Traveler’s Insurance)

We will submit insurance claims for our patients as a courtesy and according our contracts with certain payors. If payment has not been received from the insurance company within 30 days of filing, a statement is mailed asking you to follow up with your carrier. If payment is not received within the next 2 weeks, a second statement is mailed advising you that your insurance company still has not paid. We will attempt to collect the money from the insurance company, but ultimately payment of the claim is your responsibility. We encourage you to interact with us and your insurance company to assist in the proper processing of your account. Many times an insurance company will pay the account more quickly if the patient calls. Following the payment of your claim you will be follow the “Private Pay Cycle” specified below for any out-of-pocket expenses made up of applicable co-pays, deductibles, and/or coinsurance.

Medicare (non-HMO)

No patient statements are generated until Medicare has paid their portion of your claim. The deductible and/or coinsurance will be billed to your secondary (supplemental) insurance if applicable. If you do not carry a supplemental insurance policy, the hospital will follow the Self Pay Cycle guidelines.

Medicaid (non-HMO)

No patient statements are generated until Medicaid has paid. The patient will be billed for any copay amount if applicable.

Workers' compensation

No patient statements are generated for this category. The hospital will follow up with the employer and/or insurance carrier. Ideally, you should inform your employer of a work related injury in advance of receiving any medical services. If you received care at St. Cloud Regional Medical Center following an unreported injury it is very important that you let your employer know immediately to avoid delays or claim denial for non-compliance with work practices. If there is no response you’re your employer or claim is denied, the account will be changed to a private pay account and will be pursued per the guidelines of the Private Pay Cycle.

Private pay cycle

A statement is mailed approximately one week from discharge asking for payment. Payment is expected upon receipt. The bill you receive from St. Cloud Regional Medical Center is for hospital services only. You may also receive bills for professional services provided by your personal physician, consulting physician, radiologist, pathologist, anesthesiologist and/or emergency room physician if applicable. Any questions regarding these bills should be directed to the customer service number on the billing statement you received.

In each of these cases it is important that your read and understand the statement your receive. Some statements are simply informational, while others are asking you to resolve the outstanding balance. If you believe your claim denied or processed incorrectly it is important to act quickly by contacting both your health plan and our billing department.