Orlando Harmon
Understanding insurance coverage and billing procedures can be a complicated and confusing process. Westchester Medical Center offers financial assistance and insurance coverage for patients, including Medicaid and Child Health Plus. The specific insurance plans accepted may vary by location, so it is important to verify your eligibility and coverage with your insurance company.
| Characteristics | Values |
|---|---|
| Insurance accepted by Westchester Medical Center | Aetna (except Better Health Fida), Affinity (except Exchange), Amidacare, Beechstreet, Centerlight, CDPHP (commercial, Medicaid, Medicare, Child Health Plus), CHN, Cigna, Emblem Health-GHI, Emblem Health-HIP, Empire BCBS, Fidelis (Medicare, Medicaid, Child Health Plus), Healthcare Partners (commercial), Magnacare (commercial) |
| Insurance accepted by Westchester Community Health Center | Medicaid, Child Health Plus |
| General insurance advice | Westchester Medical Center notes that your level of coverage will depend on your individual health plan. If you are uninsured, you may qualify for financial assistance. Westchester Community Health Center offers free insurance enrollment help and has Certified Application Counselors to help you find an affordable and comprehensive healthcare plan. |
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What You'll Learn
Westchester Medical Center's accepted insurance plans
Westchester Medical Center works with many major insurance providers. However, it is always good to check with your insurance provider to confirm coverage, payment structures, and copays.
The following is a list of insurance carriers with which Westchester Medical Center participates:
- Aetna - All Products Accepted except Better Health Fida
- Affinity - All Products Accepted except Exchange
- Amidacare - All Products
- Beechstreet - All Products
- Centerlight - All Products
- CDPHP - All Commercial Products (HMO, POS, EPO, PPO), Medicaid, Medicare, Child Health Plus
- CHN - All Products
- Cigna - All Products
- Emblem Health- GHI - All Products
- Emblem Health- HIP - All Products
- Empire BCBS - All Products
- Fidelis - Medicare, Medicaid, Child Health Plus
- Healthcare Partners - All Commercial Products
- Magnacare - All Commercial Products
Understanding Your Insurance Coverage
The billing process can be complicated, and it is not always easy to understand what is covered by insurance and how much you will need to pay out of pocket. Westchester Medical Center provides resources to help patients understand commonly used terms in billing and insurance. For example, co-insurance refers to the portion of medical expenses that the patient is responsible for paying. This is the percentage of a bill that the patient pays, with the insurance company covering the rest. For instance, if your insurance covers 80% of a bill, the remaining 20% is your co-insurance. Additionally, an Explanation of Benefits (EOB) statement is not a bill. An EOB outlines the amount billed, how much is covered by insurance, and how much the patient owes. Doctors, surgeons, and specialists may bill separately from the hospital.
Financial Assistance
If you are uninsured, you may still be able to receive financial assistance for your hospital bills. Westchester Medical Center offers information on the financial assistance programs available by location. Additionally, Westchester Community Health Center provides free health insurance enrollment help. Certified Application Counselors are available to help individuals and families enroll in affordable and comprehensive health care plans through the New York State of Health Marketplace.
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How to understand Westchester Medical Center billing
The billing process following a hospital visit can be confusing, especially when insurance is involved. Here's a guide to help you understand the billing process for Westchester Medical Center.
First, it's important to know the commonly used terms in medical billing and insurance. Understanding these terms can help you navigate your insurance coverage and billing statements more effectively. Some key terms include:
- Coordination of Benefits (COB): This determines the primary payer of your services when you have multiple insurance providers. For example, if you have both Medicare and a commercial insurance plan, COB specifies which insurance pays first.
- Co-insurance: This is the portion of medical expenses that you are responsible for paying. For instance, if your insurance covers 80% of a bill, you typically pay the remaining 20% as co-insurance.
- Deductible: This is the amount you owe annually before your insurance starts covering costs.
- Explanation of Benefits (EOB): An EOB is not a bill. It outlines the charges from your doctor or hospital, details how much is covered by insurance, and states how much you are expected to pay. After a hospital stay, you will receive an EOB from your insurance provider, outlining the covered amount and the amount you owe.
Now, let's break down the billing process at Westchester Medical Center:
- Accepted Insurance Plans: Westchester Medical Center works with various insurance providers. These include Aetna, Affinity, Amidacare, Beechstreet, Centerlight, CDPHP (including commercial products, Medicaid, Medicare, and Child Health Plus), CHN, Cigna, and Emblem Health, among others. However, it's important to verify eligibility and coverage with your specific insurance company, as some health plans use smaller networks.
- Billing Inclusions: Hospital bills typically include charges for your room, meals, nursing care, medicines, X-rays, and lab tests. Doctors, surgeons, and specialists may bill separately from the hospital, so keep an eye out for those statements as well.
- Payment Methods: You can log in to the patient portal or use the bill pay tool to submit payments for care received. If you have questions about your financial responsibility, visit the hospital's location page where you received services. Westchester Medical Center will provide information about standard charges and how to submit for coverage.
- Financial Assistance: If you're uninsured, you may still qualify for financial assistance. Westchester Medical Center offers help with hospital bills and provides information on financial assistance programs available by location. Additionally, they offer Essential Plans that cover essential health services as mandated by the Affordable Care Act. The monthly premiums for these plans are based on your income and household composition.
Remember, understanding medical billing and insurance coverage can be complex. If you have any questions or concerns, don't hesitate to contact Westchester Medical Center directly or reach out to your insurance provider for clarification on coverage, payment structures, and copays.
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What to do if you're not insured
Westchester Medical Center treats patients with various insurance plans, and the level of coverage depends on the individual's health plan. If you are uninsured, you might qualify for financial assistance in paying your hospital bills.
If you are uninsured, there are several options to explore to ensure you receive the medical care you need. Firstly, you can look into whether you qualify for Medicaid or coverage through the Health Insurance Marketplace at www.healthcare.gov. The Marketplace helps provide access to affordable healthcare, and you may even be eligible for cost savings on premiums, co-pays, and deductibles. Savings are based on your household size and estimated income, not your employment status.
Secondly, if you are unemployed, you may be eligible for COBRA (Consolidated Omnibus Budget Reconciliation Act) continuation coverage. This federal law allows you to maintain health coverage temporarily after losing your job or experiencing other qualifying events.
Thirdly, you can explore county medical assistance programs, which are available in certain counties. These programs provide low-income, uninsured residents with access to needed medical care on a sliding scale or at no cost. Additionally, you can utilize free or income-based sliding scale clinics for preventative, routine, and primary care.
Furthermore, you can contact local universities or specialty training centers, such as dental schools, to inquire about free or reduced-cost care services. These institutions often offer various treatments at a fraction of the cost of private practices. You can also reach out to clinics and hospitals to ask about charity care, prompt pay discounts, and payment plans to make healthcare more affordable.
Finally, you can take advantage of state and federal programs for free screenings. For example, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) offers free annual pap smears and mammograms in every state. Some states also provide screening for other types of cancer. These programs may provide covered care if you have been screened prior to a diagnosis.
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Medicaid insurance for pregnant women
Westchester Medical Center treats patients with various insurance plans and offers financial assistance programs for those without insurance. Patients are advised to contact their health insurance providers to confirm coverage, payment structures, and copays.
Medicaid is a government-sponsored health insurance program for low-income families with inadequate or no medical insurance. It is available in all states, although eligibility requirements differ. Pregnant women are given priority when determining eligibility, and they are covered for all care related to pregnancy, delivery, and any complications that may occur during pregnancy and up to 60 days postpartum. Medicaid for Pregnant Women includes prenatal doctor visits, prenatal vitamins, labor and delivery, and checkups for the baby after leaving the hospital. If a woman has Medicaid when she gives birth, her newborn is automatically enrolled in Medicaid coverage for at least a year.
In Texas, pregnant women may be eligible for free health coverage during their pregnancy through the Children's Health Insurance Program (CHIP) Perinatal program. CHIP Perinatal provides limited coverage during pregnancy and two postpartum visits within 60 days of the end of the pregnancy for women who cannot get Medicaid and don't have health insurance.
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How to enrol in a Westchester health insurance plan
To enrol in a Westchester health insurance plan, you must be a US citizen or have a legal immigration status (a Green Card or Employment Authorisation Card). There are several health insurance options available, and an Insurance Plan Advisor (IPA)/Navigator can help you choose the best plan for your needs.
The Enrollment Process
The first step in the enrollment process is to schedule an appointment with a Navigator. You can do this by emailing [email protected] or calling (914) 995-6350, between 9 a.m. and 5 p.m., Monday through Friday.
At your appointment, the Navigator will ask you to provide documents that verify your income and residency status. These documents include a New York State ID (e.g. a driver's license) and income documentation. They will then be able to help you determine which plans you are eligible for and guide you through the enrollment process.
Types of Plans
There are several types of plans available, including Medicaid, ChildHealth Plus, the Essential Plan, and the Small Business Marketplace. Enrollment in these plans is available all year round.
The Essential Plan is a low-cost/no-cost health plan with monthly premiums determined by income and household composition.
Enrollment in a Qualified Health Plan (QHP) must occur during the Open Enrollment period, unless there is a Qualifying Life Event. Qualifying Life Events include marriage or domestic partnership, birth, adoption, loss of essential coverage, change in income or job, etc. Open Enrollment typically runs from November to January each year.
If you are over 65, you may qualify for coverage through Medicare. If you are under 65 and have a disability, you may also qualify for Medicare, Social Security Disability Insurance (SSDI), or Supplemental Security Income (SSI) Disability.
Other Information
It is important to understand the billing process and what is covered by your insurance. Hospital bills include charges for your room, meals, 24-hour nursing care, medicines, X-rays, and lab tests. Doctors, surgeons, and specialists may bill separately from the hospital.
Your level of coverage will depend on your individual health plan. You can reach out to your health insurance provider to confirm coverage, payment structures, and copays. If you are not insured, you might qualify for financial assistance in paying your hospital bills.
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Frequently asked questions
The insurance plans accepted vary depending on the specific Westchester Medical Center location. For example, Westchester Community Health Center accepts Medicaid and Child Health Plus, while Westchester Medical Center Advanced Physician Services does not list specific insurance providers. It is always best to contact the hospital location directly to confirm.
If you are uninsured, you may qualify for financial assistance to help pay for your hospital bills. You can also look into enrolling in an affordable healthcare plan through the New York State of Health Marketplace.
The coverage provided by your insurance plan depends on the individual plan. Contact your insurance provider to confirm coverage, payment structures, and copays.
Hospital bills include charges for your room, meals, nursing care, medicines, X-rays, and lab tests. Doctors, surgeons, and specialists may bill separately from the hospital.
