Frequently Asked Billing Questions

A separate account number is generated for each patient encounter or visit. This enables us to bill for the charges and diagnosis that specifically relate to your care for that date of service. This is necessary for your insurance company to apply the proper benefits.

Exception: For recurring outpatient accounts such as physical therapy or radiation therapy, a separate account is generated monthly, rather than for each visit.

If other providers were involved in your treatment during your visit, you might receive more than one bill for that visit, as each independent provider would bill for their services separately. Certain physicians help with your medical care, even though you may not meet them. Commonly, these are the doctors who read your lab results, X-rays and EKGs, among others. Such independent providers could include specialists such as radiologists, cardiologists, pathologists, surgeons and/or anesthesiologists. Please review each bill you receive for the correct contact information, so that you can get any questions you may have answered by the appropriate provider.

Note: It is possible that an independent provider may not be in-network with your insurance company, even when Valley View Hospital is. Be sure to check with your insurance carrier for any specific policy or network questions.

If other providers were involved in your treatment during your visit, you might receive more than one bill for that visit, as each independent provider would bill for their services separately. Certain physicians help with your medical care, even though you may not meet them. Commonly, these are the doctors who read your lab results, X-rays and EKGs, among others. Such independent providers could include specialists such as radiologists, cardiologists, pathologists, surgeons and/or anesthesiologists. Please review each bill you receive for the correct contact information, so that you can get any questions you may have answered by the appropriate provider.

Note: It is possible that an independent provider may not be in-network with your insurance company, even when Valley View Hospital is. Be sure to check with your insurance carrier for any specific policy or network questions.

On occasion, your physician may send a specimen collected in their office to our lab for analysis. When this occurs, you will receive a bill from Valley View Hospital for that testing. Typically, your physician will send us your healthcare coverage information along with the specimen and we will bill our services directly to your insurance for you.

Account balances are to be paid 28 days from the statement date. If you are unable to pay in full by that date, you should contact your Customer Service at (970) 384-6890 or (866) 231-7678 to discuss other resources that may be available to you.

Payment on your account may be made by the following methods:

1. Prompt pay discount on qualified charges for patients who do not have insurance.
2. Payment in full by personal check, MasterCard, Visa, Discover, American Express
3. Interest free financing that allows you to pay your bill in up to 12 equal monthly payments and a minimum of $75 per month. Please call Customer Service at (970) 384-6890 or (866) 231-7678 to make arrangements.
4. Financial Assistance may be available to patients who feel that they are unable to pay for all or part of the healthcare that they received from Valley View. All patients who feel that they may be eligible are encouraged to apply.

Financial assistance application forms are available from Customer Service or online.

You can request that an itemized statement be mailed to you by contacting Customer Service at (970) 384-6890 or (866) 231-7678.

Valley View sends an itemization to you on your first statement.

This is a courtesy call from Customer Service to verify that you have received your statement and to make sure that the information we have is correct. We provide this call as a way of assisting in insurance filing, address changes, providing resources to assist with your balance and education on payment guidelines.

You may contact us by emailing to vvhcs@vvh.org, by calling (970) 384-6890 or (866) 231-7678 or you may visit Customer Service located off the second floor lobby across from the Family Birth Place. Each family is assigned a unique customer service representative to assist them with all of their accounts.

The billing mailing address is:

Valley View Hospital
PO Box 2270
Glenwood Springs, CO 81602-2270

A patient’s status is not strictly determined by how long the patient is in the hospital. Many factors are considered to determine a patient’s status, including the severity of the patient’s condition and the intensity of the treatments to be provided to the patient.

Though Inpatients typically stay longer than most Outpatients (including those receiving Observation Services), it is possible for some Outpatients to remain in the hospital for several days and for some Inpatients to be discharged in less than a day.

For more information, please see this publication by the Centers for Medicare & Medicaid Services.

As a courtesy, we will file a claim to your insurance. Once we receive notice that your claim has been processed, we will send you a statement of any amount that is due. If your insurance does not respond directly to us within an appropriate time frame, you will receive a statement showing the full amount due.

Each insurance company has the right to determine their payment amount, which is sometimes called “usual and customary”. We do not accept usual and customary allowances as determined by private insurances as payment in full. These balances will be your responsibility. We will provide any additional documentation, when appropriate, to help process your claim for maximum benefit.

Regulations require that all codes supported by the patient’s medical record for a given visit be listed on every claim submitted to any governmental or commercial payer for that visit. Coders must code all diagnoses submitted by the ordering physician, all procedures performed and all results of those procedures. They must also follow established, professional guidelines in doing so. According to those rules, a test can only be coded as preventive or ‘screening’, when the patient is having it done without any related diagnosis, signs or symptoms. If the patient does have past or present symptoms or disease related to the test, it must be coded ‘diagnostic’. This is true even when the word ‘screening’ appears on an order, if that order also includes a related diagnosis and/or signs or symptoms.

Additionally, some tests that start out as a screening may end up with diagnostic codes as well. This happens when something is found during the test, especially if it leads to additional procedures being performed during the visit. The most common instance of this is with a colonoscopy, where polyps that are discovered during the procedure are usually removed during that same procedure. (They would normally be sent to a lab for analysis as well.) While the primary code for the colonoscopy would still state ‘screening’, additional diagnostic and procedure codes for the polyp removal (and analysis) must be added. Depending on the patient’s specific insurance policy, the addition of these codes could cause the patient’s co-pay, deductible and/or coinsurance to come into play.

Please contact your insurance company directly. If you need to appeal a claim with the insurance company, they will instruct you on the procedure that you need to follow up.

What are self-administered drugs (SADs)?

Medicare calls any drug that a patient would normally take on their own, a “self-administered drug”. Generally, Medicare does not pay for such self-administered drugs while you are in an outpatient setting, unless the drugs are required for your outpatient service. Instead, Medicare requires that the hospital bill you for those drugs directly. However, you can then submit the bill to Medicare Part D for a refund. Valley View also provides an option for you to bring your own medications for your stay, as long as you meet the following requirements:

– Your physician must write an order stating that you can take your own home medications.

– The medications you bring from home are in their original, labeled container.

– The medications are checked in to the Valley View pharmacy for verification and kept for the nurse to administer during your stay.

For more information, please see this publication by the Centers for Medicare & Medicaid Services.

Extra: For a definition of some Common Health Coverage and Medical Terms and an illustrated example of How You and Your Insurer Share Costs, please follow this link.