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Geisinger
Phone: 800-275-6401
 
 
 

Frequently Asked Questions

My insurance should have paid my bill, what should I do?

  • Verify that your insurance company has received and processed the claim. If they have not,
  • Review your insurance policy to determine if the service is covered. If you are unable to determine this, call your insurance company to determine if the procedure is covered. Your insurance company will have the most accurate and up to date information about your policy and your claim.
    - If your insurance company has questions for Geisinger Health System, please have them call the Patient Service Call Center at 800-640-4206.
  • Call the Patient Service Call Center at 800-640-4206 to verify we have the most up to date insurance information on file for you.
    - We can bill your insurance company only if you provide us with accurate and up to date medical insurance information.

How is my insurance company billed?

1. If your insurance is Medicare, Geisinger Health Plan or Pennsylvania Medical Assistance:
We submit all covered charges to your insurance company and receive direct payment to the extent of your coverage. You are responsible for deductible, co-insurance and non-covered service amounts, which are reflected on your billing statement. For more information regarding your insurance coverage, please use following links:

2. If your insurance is Highmark:
We submit all covered charges to Highmark. If we receive direct payment, your billing statement will reflect the deductible, co-insurance and non-covered service amounts. If Highmark sends payment to you, your billing statement from Geisinger will reflect full charges and you are responsible for such. For more information visit:

3. If your insurance is another insurance plan or a commercial, worker's compensation or no-fault plan:
We submit all covered charges to your insurance company and receive direct payment to the extent of your coverage if you have signed the appropriate authorization forms. If so, your billing statement will reflect only the deductible, co-insurance and non-covered service amounts and you are responsible for these charges. If you have not authorized your insurance company to make direct payment to Geisinger, you will be billed immediately for total charges.

4. If your insurance is major medical:
You are responsible for filing all major medical claims. This statement can be used to file a claim to major medical. Please contact your insurance company or employer for how and where to submit your major medical claims.

5. Insurance inquiries:
If you have questions regarding your Geisinger billing statement, contact the Patient Service Call Center at 800-640-4206 during our normal business hours and one of our staff will assist you. Please Note: if your insurance company (except Medicare and Medical Assistance) does not pay within 60 days or rejects claims in part or full, you will be billed directly for the unpaid balances.

Will my insurance cover my Geisinger visit?

Your insurance policy specifies whether or not services offered by Geisinger Health System will be covered. If you are not sure if a service is covered we suggest you contact your insurance company. Their telephone number should be on your policy and your insurance identification card. Click for a list of insurance plans Geisinger accepts.

To identify insurance types your Geisinger clinic participates with, click to search for your clinic site. Enter your zip code, click on your clinic and then click on the "insurance" link.

My insurance has changed, what should I do?

In order for your claims to be paid promptly, Geisinger needs your most up to date insurance information. Having this ensures that we bill the correct insurance company. Always bring your current insurance card to appointments and make sure that Geisinger Health System has your most up to date insurance information. If your insurance has changed, please advise the receptionist when you check in for services. You may also call the Patient Service Call Center at 800-640-4206 to update your insurance information. Providing Geisinger Health System with your most up to date insurance information will expedite the processing and payment of your claims.

I have insurance. Why did I get a bill?

As a courtesy to you, the patient, Geisinger Health System bills your insurance company directly for services rendered. The charges become your responsibility if your insurance company does not pay them, so it is important to provide accurate insurance policy information at the time of your appointment.

Can I pay all or part of my statement with my Visa, MasterCard, American Express or Discover card?

Write your credit card information in the space provided on the front of your statement or call a Patient Service Coordinator at 800-640-4206 or pay online at geisingerwebpay.org.

Already paid?

Payments received after the statement date will appear on your next statement.

How do I change the mailing address on my statement?

Fill out the change of address section on the statement when sending in your payment. The change of address section is on the back of the first page of your statement.

Why is the physician's name on my statement different from the physician I saw?

Because Geisinger is a teaching facility, the physician name appearing on your statement is the supervising physician. This name may differ from the actual physician you saw.

Will my insurance pay for the charges listed on my statement?

The balance on your statement represents all of your charges less payment received from your insurance company. Geisinger Health System requests payment in full for the patient balance indicated on this statement within 10 days of receipt of the statement. Payment arrangements can be made by calling the Patient Service Call Center at 800-640-4206.

What/where is my medical record number?

Your medical record number appears on both the return portion and the receipt portion of the statement. This is your unique patient identifying number.

Payment options?

In addition to personal checks and money orders, Geisinger accepts Discover, American Express, MasterCard, and Visa. You can also pay your bill online at
geisingerwebpay.org or you can mail your payment. Checks should be made out to Geisinger Health System and can be mailed to Geisinger Health System, P.O. Box 27727, Newark, NJ 07101-7727.

Glossary of Terms

Below are some common terms in which you should be familiar.

Price Transparency:
Charge -
The dollar amount a provider sets for services rendered before negotiating any discounts. The charge can be different from the amount paid.
Price - The total amount a provider expects to be paid by payers and patients for healthcare services.
Cost - The definition of cost varies by the party incurring the expense:

  • To the patient, cost is the amount payable out of pocket for healthcare services.
  • To the provider, cost is the expense (direct and indirect) incurred to deliver healthcare services to patients.
  • To the insurer, cost is the amount payable to the provider (or reimbursable to the patient) for services rendered.
  • To the employer, cost is the expense related to providing health benefits (premiums or claims paid).

Responsibility Reasons:
Deductible - The amount you must pay for medical treatment before your health insurance provider starts to pay. For example, $1000 per individual or $3,000 per family. In most cases, a new deductible must be satisfied each year.
Co-insurance - The part of your bill, often in addition to a co-payment, that you must pay. Co-insurance is usually a percentage of the total medical bill. For example, 20 percent.
Co-payment or "co-pay" - The part of your medical bill you must pay each time you visit the physician. This is a pre-set fee determined by your health insurance provider.
Non-covered charges - These are costs for medical treatment that your insurance provider does not pay. It is the patient's responsibility to determine if treatment is covered by their health insurance provider before being billed.

 

Provider-Based Outpatient Billing

Q: What does "provider-based" or "hospital-based outpatient" mean?
A: "Provider-based" or "hospital-based outpatient" refers to the billing process for services rendered in a hospital outpatient clinic or location. This is the national model of practice for large, integrated delivery systems involved in patient care.

Q: How does this affect billing?
A: Under this model, patients may potentially receive two (2) charges on their combined patient bill for services provided within a clinic. One charge represents the facility or hospital charge and one charge represents the professional or physician fee.

Q: Why does Geisinger do "provider-based" billing?
A: Since Geisinger employs many physicians, following this same type of billing process for outpatient care rendered at our hospitals ensures more appropriate payment for services provided by hospital staff and physicians and distinguishes facilities that function as departments of hospitals from those which are freestanding.

Q: Does this mean patients will pay more for services?
A:
Depending on their particular insurance coverage, it's possible patients may pay more for certain outpatient services and procedures at our provider-based/hospital outpatient locations than at one of our other sites.We recommend patients review their insurance benefits or contact their insurance provider to determine what their policy will pay and what out-of-pocket expenses may incur. Please note some lab tests drawn at a freestanding clinic may be sent to a hospital or other facility for processing and also show a "hospital outpatient lab charge".

Q: What are Geisinger's "provider-based" or "hospital-based outpatient" locations?
A: Click for a list of Geisinger hospital-based locations. Other locations will be included as Geisinger expands services to meet patient needs.

Q: Does this affect patient co-pays or deductibles?
A: Depending on each patient's specific insurance benefits, additional patient out-of-pocket expenses may be incurred by the "provider-based" model.

Q: Where can patients call with their questions or concerns?
A: Geisinger's Patient Service Call Center toll-free at 800-640-4206

Q: What can patients do if they are having difficulty paying for healthcare services?
A: Geisinger Health System offers discounting and charity policies to help qualifying patients. Detailed information is available by calling Geisinger's Patient Service Call Center toll-free at 800-640-4206.

In Summary: Receiving care at Geisinger's "provider-based" locations may result in a facility charge as well as a professional or physician charge for outpatient services and/or procedures. These charges will be reflected on the patient statement you receive for services provided. Depending on a patient's specific insurance coverage, it is possible that some patients may pay more for these services and procedures than they would at one of our other sites. Geisinger is not unique in this regard as this is the case in many integrated healthcare delivery systems across the country.

Patients are advised to review their insurance benefits or contact their insurance provider to determine what their policy will cover and identify any out-of-pocket expenses. For more information please contact our Patient Service Call Center at 800-640-4206 if you have further questions regarding "provider-based" or "hospital-based outpatient" billing.