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What to Bring
Our goal is to make you feel comfortable and to receive the medical services you require as quickly as possible. Upon your arrival to Adena Health System, you will be greeted by a Patient Intake representative. The representative will collect pertinent demographic and insurance information from you for clinical and billing purposes. Please have the following items available:
- All active insurance cards
- A picture ID
- Physician Orders *
- A list of current medications (if visiting the Emergency Room or Urgent Care)
* Please be sure to follow pre-procedure instructions given to you by your physician or the instructions contained on the physician order. This will help to prevent unnecessary delays in your treatment.
Patients under the age of 18 must be accompanied by a parent or legal guardian when requesting services.
If you are to be admitted to the hospital, we recommend you leave all valuables at home.
If you are having surgery, bring a copy of your living will, power of attorney, and DNR orders.
If you have a scheduled appointment, please arrive at the time communicated to you by the person who scheduled your appointment.
About Your Hospital Bill
Our Business Office is open for your convenience Monday through Friday from 8:30 a.m. to 4:00 p.m. You can reach us by telephone at 740-779-4200 or 800-975-7541.
The following payment options are available to help you pay the part of your bill not covered by your insurance:
- Pay your bill in full by cash, check, or credit card (MasterCard, Visa, Discover, or American Express). Credit card payment is accepted by phone, mail or in person.
- Arrange an interest-free payment plan through our Customer Service department. For details, please refer to our Uninsured Patient Discount policy. (link policy)
Adena Health System Financial Assistance Programs
Adena Health System is committed to serving our community, regardless of their ability to pay. Click here for Application of Financial Aid.
Adena Health System has four programs to help you with the cost of your medical care:
- Medicaid
- Hospital Care Assurance Program (HCAP)
- Community Financial Assistance Program
- Uninsured/Underinsured Patient Discounts
To apply or learn more about these programs, please contact a Financial Counselor at 740-779-8296 or 740-779-7428.
Billing FAQ
1. Will you bill my insurance?
We will bill your insurances for the charges from your visit to Adena Health System.
Depending on the type of services provided to you on your visit, you may receive an additional bill from one or all of the following providers of care. Please contact them directly for bill inquires:
· Chillicothe Anesthesia 740-774-2374
· Chillicothe Radiology 740-774-1111
· New Century Emergency Physicians 800-875-7374 ext. 2076
· Byron Smith, M.D., Inc. (pathologist) 740-774-3023
· In addition, your physician may be sending a bill for services provided. Please contact your physician’s office with questions.
If there has been a change to your insurance from what was listed on your statement, please call us at 740-779-4200 or 800-975-7541.
2. When will I receive a bill?
Although we can’t guarantee how soon we’ll hear from your insurance provider or how much of the costs they will cover, you should expect to receive a billing statement 45 to 60 days after your visit. The billing statement will show:
- The cost of service
- How much you owe
- When your payment is due
You may receive more than one billing statement from us until all charges are paid.
3. How do I request an itemized statement?
You may request an itemized statement by calling our customer service department at 740-779-4200 or 800-975-7541.
4. Will you bill my secondary insurance?
Regardless of who your primary insurance provider is, we will bill your secondary insurance as a service to you.
After we hear from your primary insurance, we will bill and expect to hear from your secondary insurance within 60 days. If we do not receive payment from your secondary insurance carrier within 60 days, you may receive a statement from us.
Please keep all of the payment information you receive from your primary insurance company. If we are unsuccessful in collecting payment from your secondary insurance, you will need the payment information when you contact them.
5. What are your business hours?
Our Customer Service representatives are available Monday – Friday from 8:30 a.m. to 4:00 p.m.
6. Where is the Business Office located?
Our address is 110 Vaughan Lane. We are located just south of the State Highway Patrol and west of Adena Regional Medical Center.
7. Where do I send my payment?
Payments can be made in person at the Business Office at 110 Vaughan Lane or the Cashier’s office at either Adena Regional Medical Center or Greenfield Area Medical Center.
Payments also may be mailed to:
Adena Health System
Dept. L 637
Columbus, OH 43260
8. Is financial assistance available?
Yes, Adena Health System offers a variety of financial assistance programs. Please contact a Financial Counselor at 740-779-8296 or 740-779-7428 for eligibility requirements. Click here for Application of Financial Aid.
9. Do you accept my insurance?
Adena Health System accepts many insurance plans. Please contact your insurance company if you are unsure of your coverage.
10. What types of payments are accepted?
We accept MasterCard, Discover, American Express and Visa. We also accept personal checks and money orders. Cash payments are accepted at the Business Office or the Cashier’s office at ARMC or GAMC.
Glossary of Terms
Basic & Supplemental Care: Basic health care services that an HMO is required to offer. They generally include: 1) Physician’s services; 2) Inpatient hospital services; 3) Outpatient medical services; 4) Emergency health services; 5) Diagnostic laboratory services and diagnostic and therapeutic radiology services; 6) Preventative health services.
Capitation: Capitation is a method of payment from the HMO to the primary care physician. The payment is not for services rendered, but to the number of members who have chosen that doctor as their PCP.
Community Rating: Community rating is a method of HMO rate calculation where the rate charged to a group or to an individual for HMO coverage is based on the profit or loss experience of the HMO’s entire population.
Coordination of Benefits: The method of determining which company pays as primary insurer and which company pays as secondary or excess insurer when a working couple or their dependents have a claim covered by more than 1 group insurance contract.
Copayment/Out-of-Pocket Expense: The amount of dollars the member must pay for a service, a minimum part of the entire charge for any given service. HMO pays the remaining charges.
Deductible: The amount of dollars that the member must pay to the provider before a health plan is obligated to make any payment.
Experience Rating: Experience rating is a method of HMO rate calculations where the rate charged to a group for HMO coverage is based on the profit or loss experience of that particular group.
Fee for Service: Fee for Service is a method of payment from the HMO to the physician for services rendered to HMO members the physician is paid a fee for service.
Fixed Periodic Prepayment: The periodic prepayment is the "rate" or "premium" established by the HMO to be paid by or on behalf of the subscriber at specific intervals in return for basic and supplemental health care services.
Gatekeeper Concept: A system under which the member must select a primary care physician who in turn provides or authorizes all care for the particular member. Any referrals must go through primary care physician. The PCP can open or refuse to open the gate between the member and the health care provider.
Grievance: This procedure is a function required by law, which gives a dissatisfied member the opportunity to file a written complaint with the HMO and move through several administrative layers in an attempt to get the complaint resolved.
Health Care Facility: This may be a hospital, urgent care center, skilled nursing facility, or mental healthcare facility.
Managed Care: An organized method of providing healthcare services; it involves a 3rd party in the planning, approval, and monitoring of an HMO member’s healthcare.
Medical Emergency: Medically necessary services immediately required because of unforeseen illness, injury or condition.
Medical Necessity/Utilization Review: A general requirement for HMO coverage of any procedure or treatment: that the treatment is necessary for the medical health of the member; that not receiving such treatment would amount to substandard medical care. Utilization review is an activity conducted by the HMO, which monitors the healthcare services and supplies received by HMO members. This is one measure of the quality of care. Types of utilization reviews:
Preadmission Certification: The HMO is notified before a member is admitted to a hospital. A decision is made to either 1) approve the hospital admission; 2) deny the hospital admission; 3) disapprove the request altogether based on the absence of needed necessity or ineligibility for coverage under this policy.
Concurrent Review: An HMO representative goes on site at the hospital during a member’s hospital stay to access the level of care needed and the estimated discharge date.
Retrospective Review: The HMO, in hindsight, evaluates the patient diagnosis and length of hospital stay. It determines whether all treatment and the length of stay were appropriate.
Open Enrollment: After two years of operation, an HMO must hold a 30-day open enrollment period at least once every year. During this open enrollment period, it must accept individuals up to its capacity on a first-come, first-served basis. Public notice must be provided and capacity is at the discretion of the Director of Insurance. The HMO is exposed to possible "poor risks" and may lose money on this group as a whole. Open enrollment period for employers are times when the contract is being renewed and new members may join.
Out of Area Services/Non Participating Providers: Out of area care is a benefit an HMO provides to its members. Out of area care allows for treatment of an enrollee when outside the geographical limits of the HMO. The treatment is usually restricted to emergency care. Providers are hospitals, clinics, physicians, dentists, optometrists, pharmacies, nursing homes, home health agencies, etc. Non-Participating providers would not be under contract with the HMO.
Participating Provider: A participating physician or specialist under contract with the HMO.
Primary Care Physician: Physician who provides or authorizes all care for that particular member, any referrals to specialists must be authorized.
Primary Care/Specialty Care: Primary care is rendered by a physician, which is routine in nature; care which does not require a specialist. Specialty care is care rendered by a specialist in a specific field such as: cardiologist, neurologist.
Prior Authorization/PreCertification: Prior authorization is receiving permission from the HMO’s Medical Director, as required by the Evidence of Coverage, before a certain medical procedure is performed.
Quality Assurance: An activity conducted by the HMO whereby the HMO monitors the quality of healthcare services rendered to its members. This activity is required by law, and the state performs quality assurance audits at least once every 3 years.
Referral: A Referral is given by the member’s PCP when there is a need for the member to see a specialist. Without a referral from the PCP, the treatment may not be covered.
Restrictions on Choice of Providers: Members must use participating providers of the HMO to ensure coverage.
Risk Sharing: Is a financial arrangement between the HMO and its providers whereby the provider shares some of the loss if an HMO’s utilization or medical costs cause an unexpected operational deficit. The provider also shares in the profits.
Self-Referral/Point of Service Contract: Self-referral is the act of allowing the member to decide when he needs to see a specialist. The member makes his own appointment without any prior authorization or referral from HMO or the PCP. In such "open access" systems, patients make their own appointments with specialists, rather than always having the point of service originate at the PCP.
Service Area: Service area is the part of the State that the HMO is licensed to operate in. The HMO can only enroll people who live within the service area.
Solicitation Documents: Advertising materials.
Supplemental Health Care Services: Are the services that an HMO may offer, but is not required to offer. For example: prescription drugs, vision care, dental care, etc.
Urgent Care: Medical care which is necessary when a member’s condition must be treated very soon to ensure that the condition does not worsen. Urgent care is for conditions not as severe as conditions requiring emergency care.
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