Understanding Your Payment Options

Thank you for choosing JRMC for your healthcare. In our ongoing efforts to provide cost-effective healthcare and good customer service, we need and appreciate cooperation regarding your financial responsibilities and payment options. The enclosed information is a financial summary for your benefit. These policies apply to all procedures and departments.

Insured Patient

Financial Responsibility: Payment of co-payments and standard deposits are required prior to scheduled service or at the time of service. A JRMC representative will contact you prior to your visit to discuss and arrange payment.

Uninsured Patient

Financial Responsibility: If you do not have insurance, payment of a standard deposit will be collected prior to, or at the time of, service. A JRMC representative will contact you prior to your elective procedure to arrange a full payment or to discuss payment plan options. Elective or non-urgent service may be delayed until payment is received or insurance obtained.

deadlines and forms

All outstanding amounts on your statement are due within 15 days of receipt.

We accept Visa, Mastercard, Discover, American Express and major debit cards. Other payment methods accepted are checks, auto-withdrawal and e-Bill.

JRMC is happy to provide you with e-Bill Express. By using this service, you can view a detailed summary of your bill, make a quick Pay-Now payment, view the status electronic payments and receive e-mail receipts for all payments. When signing up for this service, you will receive e-mail confirmation within a few business days.

Short-term Interest-Free Loans:
6-18 months depending on balance and are available upon request. Payment terms will change with each additional account added to your loan.

Extended Loans are available through:
OneMain Financial • (701) 252-6516 www.onemainfinancial.com
Med Loan Finance • (800) 504-4053 www.medloanfinance.com

Responsible Party
In compliance with state and federal law, all patients 18 years and older will be identified as the guarantor or the responsible party for services provided.

Referrals
For any out-of-network primary care physicians, you will need to obtain a referral. Failure to do so may result in reduced or no benefits from the insurance company. If this occurs, the entire balance will be your responsibility.

Pre-Authorization
Most insurance companies require pre-authorization before a scheduled procedure or being admitted to the hospital. Failure to obtain pre-authorization may result in the insurance company refusing your claim. If this occurs, the entire balance will be your responsibility. You may be required to pay your claim until you resolve the authorization issue with your insurance.

Medicaid
Services for Medicaid (Medical Assistance) patients will be filed for the states of North Dakota, Minnesota and South Dakota. If assistance is offered from another state, payment of the services you receive and the filing of your own claims will be your responsibility.

Claim Filing
JRMC files claims with your insurance company as a courtesy. Payment remains the ultimate responsibility of our patients, so JRMC does not enter into disputes over insurance benefits. Usual and customary charges are determined and set by your insurance company and do not reflect our local, regional charges.

Insurance and patient billing are done in accordance with all federal, state, and other contractual requirements in cases where JRMC has an agreement or is a participating provider. If a payment is sent directly to you, please sign and deliver the check to the JRMC Business Office. The check balance will be applied to your account.

Waiver of Confidentiality
You understand that if this account is submitted to an attorney or collection agency, if we have to litigate in court or if your past due status is reported to a credit agency, the fact that you received treatment at JRMC may become a matter of public record.

Community Care
Community Care, or Charity Care, is available to those who are unable to pay for care and meet JRMC’s Financial Assistance Policy and American Hospital Association guidelines. For eligibility information, instructions on how to apply or questions regarding financial assistance, please contact our financial counselor in JRMC Admissions.

JRMC is happy to assist you in filing healthcare claims with your insurance company(s). It is your responsibility to supply JRMC with your correct insurance information, including the policy number. Without this information, your claim is considered a self-pay account and the balance owed is due within 15 days.

The amount and kind of charges on your account depend upon the treatment you receive. We will initially submit your charges to the primary payer (such as Medicare). Upon payment by the primary payer, we will submit the remaining balance to the secondary payer (such as Blue Cross North Dakota). When all insurance company payments have been received, you will receive a statement of any amounts still owed to JRMC.

If you have any financial responsibility (co-payments, co-insurance, or deductible amounts) or if Medical Assistance should reject payment on your account, you will receive a statement for amounts owed.

You may be billed separately by a clinic or other medical specialist who provided treatment during your visit.

We appreciate your cooperation in meeting your payment requirements. Thank you for selecting Jamestown Regional Medical Center for your healthcare needs.