Medicaid & Medicare
Allegiance Health is an approved Medicaid provider. This means the hospital has signed a contract to provide services to Michigan Medicaid recipients. If you have active Medicaid coverage, Allegiance Health will bill the Medicaid program. We ask that you provide us with information about any supplemental and retirement insurance you may have. If you have other insurance coverage, Medicaid will not pay until the other insurance has paid or denied payment. This includes automobile insurance for injuries related to a motor vehicle accident.
Charges not covered by Medicaid
Some charges are not covered by Medicaid. Allegiance Health will inform you of the cost of any non-covered services and ask you to sign a Notice of Non-coverage; this is your written agreement to pay for uncovered services in full. Federal law requires that itemized medical claims for Medicaid recipients be sent directly to the Michigan Department of Community Health. A Medicaid patient may subpoena a copy of their billing from the State of Michigan.
Allegiance Health has a number of resources to assist uninsured patients with applications for Medicaid or other assistance that may be available to help with medical expenses:
- Patients in the hospital now, call (517) 788-4973.
- Patients planning care in the future, call (517) 788-4973.
- Patients who have already received care, call (517) 788-4920.
When Medicaid coverage is denied
If you are denied Medicaid coverage, Allegiance Health may refer you for assistance in appealing the denial or may be able to offer other assistance. To access help when denied by Medicaid, please call (517) 788-4920.
Medicaid Managed Care
Medicaid contracts with insurers who manage the medical care of patients receiving Medicaid. These insurers are known as Medicaid Managed Care Plans. Allegiance Health has contracts with Medicaid Managed Care Plans, including Priority Health, Meridian Health Plan and UHC Community Plan. These Plans usually require authorizations before any services are provided. It is your responsibility to work with the insurance provider to obtain any required authorizations. Allegiance Health will assist in this process whenever possible.
Allegiance Health accepts an assignment of benefits for most commercial carriers. A statement from the hospital will be sent to you 30 days after services. If the insurance company fails to pay the claim within 60 days, you will be billed for the balance on the account.
Medical claims and itemized bills
If your physician recommends that you see an Allegiance Health provider (including a hospitalist, specialist or internist) during the course of your admission, you and your insurance company may receive multiple bills from Allegiance Health.
This billing falls under the same guidelines as the hospital bill regarding participating insurances and patient responsibilities.
Allegiance Health is a participating provider with Medicare. The hospital has signed a contract with Medicare to provide services to entitled beneficiaries. Medicare patients will be billed only for deductibles, co-pays and some non-covered charges.
Medicare supplemental insurance
If you have additional insurance coverage besides Medicare, Allegiance Health will bill your supplemental insurance company for any amounts Medicare does not pay. Medicare supplemental and retirement plans may not cover the entire balances after Medicare. Amounts not paid by Medicare or other insurance will be your responsibility.
Medicare as a secondary insurance
Medicare will not cover you for your primary insurance if:
- You or your spouse is still working and is covered by an employee group health plan
- Your were involved in an automobile accident
- You were injured and some other party may be liable for the injury. This includes Workers’ Compensation claims for Medicare insured persons who are still working
In these cases, please provide information regarding the employer group insurance, automobile coverage, or the Workers’ Compensation claim. A Medicare claim will be submitted for any balance the primary insurance does not pay.
Medicare Outpatient Coinsurance Notice Provider-Based Clinic
“Provider-based Clinic” is a Medicare status for hospitals and clinics that comply with specific Medicare regulations. The below FAQs explain how you will be billed for the services received at Allegiance Health.
Medicare has designated many locations where Allegiance Health provides outpatient services as “provider-based clinics.” This designation identifies our outpatient provider-based clinics as being part of the hospital – simply located in a different place. The provider-based clinic model is common across the country for integrated health systems that offer services to their community in many locations. Receiving this designation means that this organization complies with specific Medicare regulations. Allegiance Health’s compliance with Medicare standards assures you that you are receiving high quality care throughout our many sites of care.
It is our goal to be as transparent as possible with you regarding coinsurance amounts. To do so, we are providing you with an estimate of your Part A and Part B coinsurance amounts. These amounts will vary based on the type and number of services received.
|Part A: Facility fee||Part B: Healthcare provider fee|
|Office Visit||$20||$2 - 23|
|Minor Procedure||$20 - 60||$15 - 20|
More complicated procedures such as colonoscopies and endoscopies have Part A coinsurance amounts that range from $ 0 - 127, and Part B coinsurance amounts that range from $ 26 - 61.
As a participating Medicare provider, Allegiance is required to screen Medicare patients according to the Medicare Secondary Payor (MSP) rules. At each visit, business services representatives will ask you the MSP questions. These questions will help to confirm if Medicare or another payer should process the claim as primary.
Allegiance Health has always sought ways to bring needed services to this community. By participating in this model, Allegiance will receive additional funding that will be used to support services that are important to Medicare recipients. These services include our Senior Health Center, Silver Lining Program, Hearing Center, Osteoporosis and Balance Center, and more.
You will continue to receive care by the same excellent Allegiance Health physicians and staff. However, under provider-based clinic guidelines, Allegiance is required to bill you differently than we have in the past. Your bill will now be split into two parts. You will receive one bill to cover physician fees, and a second bill to cover clinic fees – just as you receive a hospital and physician bill when you are at the hospital.
Because you will receive two separate bills, you will also have two co-pays. Most Medicare recipients will not ultimately pay more money outof-pocket, however, because many Medicare recipients also carry secondary insurance. In most cases, these secondary insurers will cover the additional co-pay expenses. If you do not have secondary insurance coverage and the co-pay changes cause you financial concern, please call (517) 788-4920. Our primary goal is for you to continue receiving the care you need.
We know billing can be confusing and we want to help make it clear for you. We would be happy to answer any additional questions. Please call Allegiance Patient Financial Services at (517) 788-4920 between the hours of 8 a.m. and 5 p.m. If you have a secondary insurance carrier, their Customer Service or Member Service department may also be able to answer specific questions for you. Often their phone number is printed on the identification card provided to you.