Financial Services

Accepted Methods of Payment

Pay Your Bill Online

Madera Community Hospital accepts American Express, Discover, Mastercard and Visa, as well as checks and money orders. Credit card payments are accepted online, using the link below, by calling customer service, or by mailing your credit card information with your patient account number to the address for patient payments listed below. Madera Community Hospital also accepts cash payments.

Address for Mailing Patient Payments:

To mail payment please include your Madera Community Hospital patient account number.
Madera Community Hospital
Attn: Patient Financial Services
1250 E. Almond
Madera, CA 93637

Financial Services Department: (559) 675-5514

Patients with Medi-Cal or Medicare Coverage

If you are currently uninsured, you may qualify for Medi-Cal or Medicare coverage.

Facts about Medi-Cal

Medi-Cal is an insurance program jointly funded by your state and federal government. Patients have 90 days from date of treatment to apply for Medi-Cal; this applies to inpatient and outpatient treatment.

Eligibility is determined by:

1. Disability due to medical reasons
2. Inability to return to work for four months or more
3. Pregnancy
4. Income
5. Assets

For more info visit www.medi-cal.ca.gov or contact the Patient Financial Services department at (559) 675-5496.

Facts about Medicare

Medicare is a federally funded health insurance program for people age 65 or older, some people with disabilities under age 65, and people with End-Stage Renal Disease. Medicare has 2 parts, Part A and Part B. Part A is hospital insurance - most people do not pay for Part A coverage. Part B is medical insurance - most people pay monthly for Part B coverage. There are limitations on a number of services and items covered by Medicare and Medi-Cal, depending on the plan you have. You are responsible for co-payments, deductibles, and other services not covered.

Medicare Premiums and Deductibles/Co-payments (2019 Rates)

Medicare Deductible and Coinsurance Amounts for 2019:

Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2019 = $1,364) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

For each benefit period you pay:

• A total of $1,364 for a hospital stay of 1-60 days.
• $341coinsurance per day for days 61-90 of a hospital stay.
• $682 coinsurance per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
• All costs for each day beyond 150 days

Skilled Nursing Facility Coinsurance

• $170.00 coinsurnace per day for days 21 through 100 each benefit period.

Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)

• $185.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $183.00 deductible.)

Additional information about the Medicare premiums, deductibles, and coinsurance rates for 2019 is available on www.medicare.gov.

Additional Resources

• Blue Cross
• Aetna
• Medicare
• Medi-Cal
• United
• HealthNet
• CCS
• CIGNA

The Financial Assistance program is designed to assist those who are low-income, uninsured or underinsured. Partial and/or full charge charity care discounts will be based upon a patient’s income, assets, family size and ability to pay as defined by the Federal Poverty Level, California Hospital Association (CHA) and American Hospital Association guidelines (AHA).

The patient is responsible for providing information requested during the qualification process and will continue to receive bills until eligibility has been determined. Please ask a financial counselor or call Patient Financial Services at (559) 675-5496 for more information about the program.

Financial Assistance Program Policy
Application

Programa de Ayuda Financiera Politica
Solicitud

Madera Community Hospital Charge Master
January 2019

Madera Community Hospital Average Charge per DRG
January 2019

If you have questions regarding the cost of a hospital based service please contact: 559-675-2747

Charges for all California Hospitals are publically available from the California Office of Statewide Health Planning & Development: www.oshpd.ca.gov

• Out-of-pocket responsibility: The amount due based on the defined terms of an individual’s insurance plan. Your out-of-pocket responsibility may include:
  • Co-payment (co-pay): A fixed amount that is requested for covered medical services at the time the service is received, as determined by your insurance plan. Example: $50 payment due for each visit to the hospital’s Emergency Department.
  • Coinsurance: This refers to the sharing of covered medical expenses by the patient and his or her insurance company. The insurance company pays a certain percentage of covered expenses and the patient pays the remainder.
  • Deductible: The part of a patient’s covered medical expenses that the individual must pay each calendar year before the insurance company starts to pay benefits.
  • Out-of-pocket maximum: A predetermined, limited amount of money that an individual must pay directly before an insurance company or self-insured employer will pay 100 percent of the individual’s healthcare expenses.

• Other Bills You May Receive

  Many physicians are independent contractors and are not employed by the hospital. Professional fees charged by these physicians, for services provided to yo,u will be billed separately. Hospital based physician groups - our Medical Partners

Other Bills You May Receive

Many physicians are independent contractors and are not employed by the hospital. Professional fees charged by these physicians, for services provided to you, will be billed by these physicians separately.

Hospital based physician groups who may bill you separately include:

Arya Medical Group (Hospitalist/Intensivist): 559-770-5142 ​

Madera Anesthesia Consultants: 877-866-9877
Regional Anesthesia Associates: 877-866-9877

Midtown Emergency Physicians Medical Group: 844-312-6794

Arthur B. Fontaine Radiology: 559-201-6724

Pistoresi Ambulance: 559-665-3001

Sierra Ambulance: 559-642-0650

Valley Nuclear Medicine Group: 800-606-9729 or 800-952-6976 (Spanish)

Madera Community Hospital’s overall goal is to provide accessible and affordable health care services to the community. We offer a number of services for our patient’s without health insurance.

Community Managed Care Rate Program

If you do not have insurance you will automatically receive our Community Rate discount. The Community Managed Care Rate program is intended to apply to uninsured patients who do not qualify for financial assistance, but still may face hardships paying their medical bills.

The Community Managed Care Rate is equivalent to an average of the contractual fee-for-service rates received from Madera Community Hospital’s contracted Managed Care payers. The Community Managed Care Rate does not apply to co-pays, deductibles, or Medi-Cal share of cost.

Financial Counselors

We understand patients may be faced with a difficult financial situation when they incur hospital bills. The hospital has financial counselors to assist and answer questions regarding coverage and payment.

Madera Community Hospital Financial Counselors are able to assist you with specific questions regarding financial coverage of your hospital stay. Call (559) 675-5496 or dial the operator (0), and ask to speak to a financial counselor. The hospital will also provide a case manager that can refer you to agencies such as the Employment Development Department, Social Security office and Madera County Health and Human Services Agency.

Madera Community Hospital will establish payment plans on your account(s) if you are unable to pay the entire balance(s) in one payment. Please contact Financial Services for specific information on the terms and conditions of the payment plans.

Madera Community Hospital
Attn:Financial Services
1250 E. Almond
Madera, CA 93637
559-675-5514

Madera Community Hospital will submit bills to your insurance carrier to help you receive the full benefit of your health insurance plan. During registration, we will obtain information to assist with accurate and timely billing. A copy of your insurance card is needed to process your claim.

Your insurance policy is a contract between you and your insurance company. You should be familiar with the terms of your healthcare plan. Most plans do not provide 100% coverage for your hospital bill. You are responsible for co-payments, coinsurance, deductibles, and other charges not covered by your insurance plan. Most plans detail exclusions, services not covered, and plan maximums - please refer to your insurance plan document for specific details regarding what is covered and not covered under your plan.

Most insurance companies issue the patient and the provider of service an explanation of benefits (EOB) when the provider files an insurance claim for services rendered. The explanation of benefits details the services rendered, information on how the claim was processed and paid by the insurance company, and the patient's share due to the provider, if applicable.

After Madera Community Hospital receives insurance payment for the claim, we begin billing the patient and/or guarantor for any patient share due. You will receive your first billing statement within 10 days of your insurance carrier paying their portion of the bill. It is the patient's responsibility to ensure payment is received by the hospital from the insurance claim and to pay any balance due after coverage has paid the claim. Your account will be subject to collection efforts and additional cost if your account isn't paid in full.

If you have questions about the patient share assessed on your account by your insurance company, or the level of benefits paid, you may contact your insurance company via telephone or internet. You may also contact Madera Community Hospital for assistance.

Two of the most common types of managed care plans are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).

If you are covered by an HMO, a PPO, or another type of managed care insurance plan, your plan may have special requirements, such as pre-certification or pre-authorization for certain procedures. Each healthcare plan has its own set of rules, participating physicians and hospitals, radiology centers, and laboratories.

If you need to update your insurance information please call (559) 675- 5556 or fax us your insurance card at (559) 675-5576.

Madera Community Hospital is a hospital-based facility. Depending on a patient’s specific insurance coverage, it is possible that some patients may incur a higher patient responsibility for services and procedures performed here. 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.

Frequently Asked Questions

Q: Why is payment requested upfront for my out of pocket responsibility?

A: The practice reduces some of the financial worry associated with a hospital visit. The upfront payment is applied toward your total hosptial charges. You will be billed for remaining balances after your insurance pays.

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 will receive a bill or bills from other physicians or medical groups involved with your care. Madera Community Hospital does not include any physician charges as part of the hospital facility charge. You will be billed separately for physician services. You are responsible to pay all charges.

Q: Why does Madera Hospital do “Provider-Based” billing?

A: 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 insurance coverage, it’s possible patients may pay more for certain outpatient services and procedures at our provider based/hospital outpatient locations. 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.

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: What can patients do if they are having difficulty paying for healthcare services?

A: Madera Community Hospital offers discounts and financial assistance to help patients, unable to pay, receive care. Detailed information is available by calling Patient Financial Services at 559-675-5514.