KSB Hospital is dedicated to meeting the healthcare needs of our community and helping as many people as we can. KSB participates in a wide range of health insurance plans and is considered ‘in-network’ for these insurance plans. In-network means that a larger portion of your medical expense will be covered and will likely reduce your out-of-pocket expense.
It is best to contact your insurance carrier to verify your specific health insurance coverage.
We have compiled some Frequently Asked Questions (FAQs) to assist you with your insurance questions. If you cannot find what you need, please contact our Patient Advocate Team at (815) 284 -4968.
DO I NEED TO BE PRE-APPROVED FOR A PARTICULAR SERVICE?
You may need pre-approval (sometimes called pre-authorization or prior authorization) from your health plan before you have surgery or receive certain other healthcare services. Through the pre-approval process, your health plan confirms medical necessity; in other words, that the service is appropriate for your condition. AS a healthcare consumer, it is important to understand which services require pre-approval. If you receive care without first obtaining a required pre-approval, your health plan may not cover your claims. Pre-approval may be required for a variety of services, such as CT scans or MRI scans, not just for surgery. When in doubt, call your health plan to find out whether pre-approval is needed.
WHAT IF KSB DOES NOT PARTICIPATE WITH MY HMO OR PPO?
If you have health insurance with an HMO or PPO plan with which we do not participate, you may still receive services at our facility. However, these services are considered ‘out-of-network’ and may not be covered. You will be responsible for paying the bill in full, or for any balance not paid by your health insurance. Check with your HMO or PPO plan to understand your policy’s limitations.
WHAT IS A DEDUCTIBLE?
A deductible is the amount that you may have to pay before your health insurance pays. Many plans offered today are called High-Deductible Health Plans where the deductible can be as high as $6,450 for a single coverage or $12,900 for family coverage. Once the patient has met his/her deductible, the insurance usually pays a percentage of the remaining bills. The patient is liable for the unpaid percentage. Deductibles are reset annually, usually beginning in January.
WHAT IS CO-INSURANCE?
Co-insurance is a form of cost sharing. After your deductible has been met, your insurance plan will begin paying a percentage of your bills. The remaining amount, known as c0-insurance, is the portion due by the patient.
HOW WILL I KNOW IF MY INSURANCE COMPANY HAS PAID MY BILL?
After your insurance company has paid its portion of your hospital bill, we will send you a statement. This statement will indicate payments and adjustments that have been posted to your account and any balance you are required to pay. You may also receive an explanation of benefits (EOB) from your insurance company.
WHAT’S AN EXPLANATION OF BENEFITS (EOB)?
An explanation of Benefits is a document from your insurance company that shows how they processed your claim. It contains information such as co-pays, deductibles or non-covered services. EOB’s should be kept for future reference.