• Balance Billing Standard Notice of Consumer Rights

Insurance Exchange Healthplanfinder

The Affordable Care Act has many options to make health care coverage more accessible and affordable for those who do not currently have health insurance or have limited coverage. Virginia Mason is dedicated to helping our patients get answers to their questions about these new insurance options.

Medicaid coverage

If you qualify for Medicaid, or Apple Health, you may apply at any time throughout the year. Applications can be made through the Washington Healthplanfinder:

• Washington state health care exchange »
• Health care exchange Phone (855) 760-0231

Insurance Definitions

• Get help understanding common insurance definitions. Learn more » 

Precertification’s, Referrals and Authorizations

Many health insurance plans have pre-certification or prior authorization requirements for specific services. In some cases referrals are required. Information about these requirements is usually listed on the back of your health care insurance card. Please refer to your card, your benefits handbook, or contact your health insurance’s customer service department.

Some important items to remember when obtaining an authorization or referral include:

• Be certain the referral is for a service covered by your health plan.
• The referral should be to a provider within your health plan's network.
• Check for limitations on the referral. For example, number of visits allowed, or expiration date.
• Contact your PCP about a referral prior to your specialty appointment 

Insurance Questions

1. How do I make sure Virginia Mason is included in my insurance plan?
2. What does “in network” or “out of network” mean?
3. Do I have to pay my co-payment at the time of registration?
4. Will you bill my insurance company for me?
5. How will I know if a service is covered by my insurance?
6. How do I follow up with my insurance company?
7. Why am I being billed when I have insurance?
8. What is an Explanation of Benefits (EOB) or Explanation of Payment (EOP)?

1.  How do I make sure Virginia Mason is included in my insurance plan?
You should contact your insurance company, see our insurances we accept list or call one of our financial navigators.

2. What does “in network” or “out of network” mean?
When a health care provider is “in network” it means the insurance company will cover a higher amount of the charges. When a provider is “out of network” you can still go to this provider, but you will be required to pay a larger percentage of the bill.

3. Do I have to pay my co-payment at the time of registration?
Yes, you are expected to pay your co-payment when you arrive. Your insurance card should indicate the dollar amount of the co-payment required for each type of service. If you have questions regarding co-payment amounts, please contact your insurance company or your employer.

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4. Will you bill my insurance company for me?
Yes, we will bill your insurance company for you, provided you have given us complete insurance information, including the name of the company, the address to which claims are to be billed, your policy identification number, your group number (if applicable), and a phone number.

5. How will I know if a service is covered by my insurance?
Health insurance policies vary widely on which procedures, services or items an insurance company will cover. In order to maximize your health insurance benefits, familiarize yourself with the policies and benefits outlined in your health insurance handbook or contact your health insurance customer service department for policy and benefit verification.

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Questions to ask your insurance company:

• Am I covered for (service/item name)?
• What is my benefit maximum?
• Do I need a prior-authorization for (service/item name)?

6. How do I follow up with my insurance company?
If your claim has not been paid and you are receiving notices from Virginia Mason, you should make a follow-up phone call to the insurance company.

7. Why am I being billed when I have insurance?
Many insurance companies have amounts which the patient must pay. These are called deductible, co-pay or co-insurance payments. If your insurance plan requires you to pay a deductible or co-insurance, the balance will be billed to you. If you have a question about why your insurance company did not pay part of a claim, you should call your health insurance company directly.

8. What is an Explanation of Benefits (EOB) or Explanation of Payment (EOP)?
These are documents showing a detailed listing of how your insurance company processed your claim or bill. An EOB or EOP is mailed by your insurance company directly to you.

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