Healthcare expenses are often unexpected or may seem overwhelming as a medical condition is discovered. Here at East Adams Rural Healthcare it is our mission to provide high quality, patient centered care, and work with you directly to ensure you have access to the services you need, locally. It is our goal to help you understand what services may cost, how insurance may cover those services, as well as assist those who may not have adequate coverage. We have many options and always want you to know that we are here to help. From estimates for services and payment arrangements, to Financial Assistance and Charity Care, our team will work with you personally to assist in finding a plan that is best for your circumstances. We hope the information provided here will help in understanding your bill and options. Below you will find a variety of helpful information including online bill pay, Financial Assistance Information and our Price Estimation Tool.
If you need personal assistance, please feel free to contact us at 509-659-5406. We are available Monday – Friday 8:00am – 4:30pm.
Thank you for choosing East Adams Rural Healthcare for your healthcare needs.
In best effort, East Adams Rural Healthcare contracts with as many insurance plans as possible. As a courtesy, we are happy to bill your insurance directly for services provided by East Adams Rural Healthcare. Because each insurance plan has different coverage allowances, benefits, and limitations, payment of services is never guaranteed and are subject to review of the specific plan being billed.
We encourage all patients to contact their plans directly or online to learn more about their specific benefits.
Aetna
Ambetter (Coordinated Care)
Amerigroup
Apple Health
Asuris
Community Health Plan of Washington (CHPW)
Coordinated Care
Department of Labor and Industries
Department of Social and Health Services (DSHS)
Medicare
Molina
Molina – Health Exchange
Premera Blue Cross
Premera Blue Cross – Health Exchange
Regence Blue Shield Northwest Health
Triwest
United Healthcare – Commercial Plans
United Healthcare Medicare Advantage Plan
United Healthcare Managed Care
United Healthcare – TriCare
Please note that this list is subject to change, and although East Adams Rural Healthcare has a contract with an insurance company, this does not guarantee coverage of the services provided.
If your plan is not listed, reach out to your insurance, they may share a network listed above. This is common, especially for employers who are considered “self-insured”. If you find that we are not contracted with your plan, let us know. We will see if that plan is interested in contracting with East Adams Rural Healthcare.
If you have questions regarding coverage of a service, it is recommended that you contact your insurance company directly.
Although we are one organization, East Adams Rural Healthcare bills separately for services provided at our Ritzville and Washtucna Rural Health Clinic’s. If you are seen in one of our clinics, labs, x-rays, or other services provided in our hospital, East Adams Rural Healthcare, those services are billed separately from the clinic services.
We will submit a claim to your insurance company for services provided. If we are contracted with your insurance company, they will make payment directly to us for your services.
Some of the services provided are billed separately and billed by a provider other than East Adams Rural Health. If you receive any of the following services, charges for these will not be included on your hospital/clinic bill:
When payment is received, your insurance informs us of what amount is your responsibility based on your plan’s coverage. Any balance remaining after insurance payment and any partial payment made by the patient at the time of service (if any) is due upon receipt of the first statement.
Statements of accounts with balances due are mailed monthly. If you are unable to make payment in full upon receipt of the first statement, we recommend that you contact our Patient Account Representative for assistance. We have a variety of payment options as well as Financial Assistance. Please note, that partial payments without an agreed payment arrangement on file will not stop an account from escalating to an outside collection agency.
With your health plan, you are responsible for certain cost sharing amounts. This includes co-payments, deductible, and/or co-insurance. There may be cases where you are responsible for additional amounts if your insurance is not contracted with East Adams Rural Healthcare. This is often referred to as “balance billing” or “surprise billing”. For services provided in our Emergency Room, however, you are protected by law from receiving a balance bill for your care. To understand your rights and details of your rights as a patient, please click the notice below for additional information.
Balance Billing Protection Act Notice
WHERE TO MAKE A PAYMENT
If you have no insurance, or are underinsured, Financial Assistance and Charity Care programs are available.
Itemized statements are available upon request by contacting our Patient Financial Services department at 509-659-5406.
If you need assistance in understanding your bill, our Patient Billing Specialists are here to help. Patient Financial Services is open Monday-Friday 8:00am – 4:30pm. We’re happy to assist you in person, over the phone at 509-659-5406.
Monthly, interest free payment installments are available if the minimum payment is met. The following minimum payments apply to the combined hospital/clinic total balance per guarantor/responsible party:
Balance Minimum Monthly Payment
0-$599 $50.00
$600-$699 $60.00
$700-$799 $70.00
$800-$899 $75.00
$900-$999 $85.00
$1,000 and over 10% of total outstanding balance
To set up monthly payment arrangements, please contact our Patient Accounts Representative at 509-659-1200, ext. 303. Please be aware that accounts may be forwarded to an outside collections agency if an account(s) is past due and/or is not meeting the minimum monthly payment. If you are unable to make the minimum monthly payment, we encourage you to contact us so we can assist you with our other Financial Assistance options as soon as possible at the number provided above.
East Adams Rural Healthcare offers Financial Assistance to those who are uninsured or underinsured. Discounts are available to those who have received services at either East Adams Rural Healthcare, Ritzville or Washtucna Rural Health Clinics. Discounts are allowed on a sliding fee schedule to individuals and families that make less than 300% of the Federal Poverty Level.
Our Patient Accounts Representative is here to assist you in completing an application for one of our programs and ensuring that your account(s) are placed on hold while applying for one of our programs.
Our Patient Accounts Representative is available Monday – Friday 8:00am –4:30pm. For assistance over the phone or to schedule an appointment, they can be reached at 509-659-1200, ext. 303.
Summary of Financial Assistance Programs
Financial Assistance/Charity Care Application
The Centers for Medicare and Medicaid Services (CMS) as part of the 2019 IPPS Final Rule requires hospitals, including Critical Access Hospitals such as East Adams Rural Healthcare make available online a list of their standard hospital charges. Effective in January of 2021, Medicare requires that all hospitals, including Critical Access Hospitals, also offer a Price/Cost Estimation tool.
Many factors may influence the actual cost of an item and/or service, including insurance coverage, rates negotiated with payers, and so on. The cost of treatment might also be impacted by variables involved in a patient’s actual care, such as specific equipment, specific supplies required, additional tests, or any other changes that may have occurred due to unexpected conditions, circumstances, or complications that may arise. Please note, that this estimation tool does not include charges that would be billed separately such as physician and pathology charges.
We support your concern in learning how much a service and/or procedure may cost and encourage you to reach out to us for an estimate. Our team can prepare a good faith estimate upon request and are happy to discuss our payment options as well. They can be reached at: 509-659-1200.
Who will bill my insurance?
A Patient Access Representative of East Adams Rural Healthcare will collect your insurance information at the time of service (if applicable). We will then bill your insurance (usually 5-10 days after services were provided) on your behalf. Once the insurance has processed the claim and has determined what the patient is responsible for, East Adams Rural Healthcare will send you a bill. There are times your insurance needs additional information from you, the patient, in order to process the claim. If this is the case, a bill will be sent to you for the total amount of the account due to let you know we need your assistance.
Why am I being asked for my insurance information again? My doctor should already have it.
In order to successfully bill your insurance, it is important that we verify your information at each visit. Our records are also separate from your primary care physician’s record, and the information isn’t always sent with referrals/orders from them. It is important to us that your records are always current and up to date, we appreciate your assistance in doing this.
I was in the hospital several weeks ago, why haven’t I received a bill?
For patients with health insurance, once your insurance company has been billed and has responded to us and advised us of what the patient responsibility is, a statement will be sent, if a balance is due from the patient. Please note, that if you insurance pays for services in full, you may not receive a statement. East Adams Rural Healthcare mails statements on a monthly basis. Please note, that it can take a minimum of 45 business days on average for an insurance company to process your claim. If your insurance has not processed your claim, or is not responding, we will notify you so that you can reach out to your insurance.
If your insurance has denied payment, we will only bill you for amounts that are deemed to be your responsibility as indicated on the Explanation of Benefits (EOB). Your insurance should send a copy of the EOB to you. If you need assistance with understanding your EOB or how your insurance processed any claims, we suggest you contact your insurance directly for assistance.
Why did my statement have an “adjustment” amount?
This adjustment amount is referring to the amount of the bill that East Adams Rural Healthcare has agreed not to charge you in agreement with your insurance company. Insurance companies, if contracted with the hospital, pay the hospital at a discount, or “negotiated” contract rate. When the insurance company pays their portion, the discounted amount (adjustment) is taken off to show the true amount due from the patient (co-payment, co-insurance, and/or deductible). For example, a hospital may charge $3,000.00 for an MRI, the allowed (negotiated rate) amount is $1,500.00. Below is an example of how patient responsibility is calculated:
Total Billed Amount: $3,000.00
Contractual Adjustment: -$1,500.00
Remaining Balance: $1,500.00
Patient Deductible: $500.00
20% Co-Insurance $200.00 (20% of the $1,000.00 remaining after deductible)
Insurance Payment $800.00
Total patient responsibility: $700.00
I have coverage under my own insurance through my employer, as well as my husband’s. Since the deductible is less with his insurance, can I use his insurance instead of mine?
Unfortunately, no. Under a provision called “Coordination of Benefits”, the hospital is required to bill the insurance that would be considered primary for you, which would be your own. Your husband’s insurance would be secondary. Any health insurance which you are the primary holder, must be billed before any other insurance. If you have dependents with more than one insurance, such as children who are covered by both parents. The “Birthday Rule” would apply. The primary insurance would be determined by whichever parent’s birthday came first by month (not year of birth).
What if my service is related to an accident or injury, such as an automobile accident?
If you seek treatment for an accident related illness or injury, please let our Patient Access staff know of this at the time of service. Additional information will be needed from you in order to bill any insurance appropriately. We can bill your personal insurance and auto insurance. If another insurance, other than your own is involved, we can bill this as well in certain circumstances. In these situations, any insurance involved often reaches out to the patient/injured to gather additional information. When this happens, the insurance company will hold claims from payment until you provide the needed information. If this occurs, we will notify you of this and the total bill may be your responsibility until you respond and provide the requested information.
What if I am in the middle of a lawsuit?
If you have retained an attorney and intend to sue another party, it is important you or your attorney notify East Adams Rural Healthcare of this. In order for us to work with your attorney, a release of information should be placed on file giving us permission to work with them on your behalf. East Adams Rural Healthcare is not obligated to hold an account in an effort to wait for settlement. We suggest you call and discuss these situations with us. Often payment arrangements will be needed to protect the account from escalating to collections. Ultimately, payment for services provided are the responsibility of the patient and/or the responsible party.
Who is responsible for payment and follow-up with the insurance company?
If you are 18 or over, you are legally responsible for your own account, regardless of who carries your insurance, if you are claimed as a dependent on another person’s taxes, or who you live with. If the patient is under the age of 18, BOTH parents, despite divorce or legal separation, or the legal guardian are responsible for payments.
We encourage you to know the specifics of your insurance plan, its exclusions and limitations of benefits, co-pays, co-insurance, and deductible amounts, second opinions, pre-authorized services, preferred providers, covered and non-covered services. East Adams Rural Healthcare does request pre-authorization from your insurer for services that require this. This DOES not guarantee payment. Payment will be made according to your contract with your insurance.
East Adams Rural Healthcare can provide you with the medical information needed to dispute and/or appeal if you disagree with how your insurance processed your claim for services provided.
Can I find out how much I will need to pay?
Not only do we offer our online pricing estimator tool, but one of our Patient Accounts Representatives can provide you with a good faith estimate. Some services are difficult for us to estimate unless we know exactly what your physician plans to order. If you have a signed physicians order, this is best. The estimate provided would be a “best estimate” based on the information gathered from any order(s) provided. If you are insured, it will also take into consideration your how your insurance covers that service. Estimates can be provided prior to, or at the time of service for most services. Some services such as Emergency Room, Observation, and/or Inpatient services are difficult to estimate due to the circumstantial nature of the services being provided. However, we are happy to discuss your insurance coverage in these circumstances.