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School of Medicine
- To Obtain Information Regarding Your Insurance
- YOU WILL RECEIVE TWO BILLS: Physician and Hospital
- Hospital Bill
- Physician/Professional Fees
- Patients Who Do Not Have Health Insurance
The Department of Psychiatry understands that health care can be very expensive and accumulating bills can increase stress. We want to provide you with as much information as possible so that you can make an informed decision about where to receive services and how those services will be paid.
The Psychiatry Admissions Office will attempt to verify and explain your insurance benefits and estimated liability. However, it is your responsibility to consult with your insurance company, understand your benefits, and address coverage concerns. We are not able to confirm the accuracy of the benefits quoted to us by your insurance provider. Our explanation or quote of your benefits is NOT a guarantee of bill payment. We are only repeating the benefit information that was provided to us by your insurance company’s representative. Again, we strongly recommend that you speak directly with the insurance company to make sure that you completely understand your coverage and financial responsibility.
The Psychiatry Admissions Office attempts to authorize your treatment with your insurance provider on the day of (but prior to) admission. Please note that most insurers consider psychiatric admissions emergent in nature and therefore will not allow authorization until the patient is physically in our admissions office. Clinical information will be provided to the insurance company explaining the reason that treatment is needed. Insurance companies have criteria that they use to determine whether a condition meets inpatient ‘medical necessity’ in order to cover cost associated with treatment. The insurance company may or may not agree to authorize treatment based on the information provided. You and/or your physician may believe that a specific type of treatment is needed but the insurance provider may disagree and refuse to authorize payment for treatment. Should this occur, you (excluding Medicare and Medicaid recipients) can choose not to use your insurance and would be fully responsible for all bills associated with the unauthorized treatment.
Please note that your insurance company’s authorization of treatment is NOT a guarantee of bill payment. Even if the insurance company authorizes treatment, they may later determine that there were insufficient benefits for treatment and not pay for the care.
Example: Your insurance policy states that they will cover 100% of your hospital and 100% of your physician charges for 30 inpatient days per calendar year. You are authorized and hospitalized for 45 days. Although your insurer authorized treatment for 45 days, your benefits only cover 30 days per year; therefore you are responsible for all charges for those 15 additional days.
You are financially responsible for whatever your insurance plan does not cover. You are also responsible for any co-pays or deductibles assigned by your insurance plan.
Review the written information provided to you by your insurance company. Also, contact the insurance company by phone and ask specifically about your inpatient mental health/ psychiatric benefits. Telephone numbers for insurance benefit information are usually printed on the back of your insurance card. It is the responsibility of your insurance company to identify and clarify your benefits. We recommend documenting the name and phone number of the individual you speak with at your insurance company. You may also contact the Human Resources Department at the company where you purchased the policy.
It is important to verify with your insurance company whether inpatient mental health/psychiatric services at The Johns Hopkins Hospital, located at the East Baltimore Campus, 600 N. Wolfe Street, Baltimore, MD 21287 are covered at the highest benefit level. Many times they will describe this as being ‘in network’ or ‘out of network’. You will need to understand the percentage of your treatment that your insurance company is agreeing to pay, as you may be responsible for the remainder.
When asking for benefits, it is important that you ask for inpatient mental health/psychiatric benefits, as many times these are very different from your medical/surgical benefits.Generally, your insurance company will pay what is “usual, reasonable, and customary” (UCR) according to their fee scale. That is, the insurance company will pay what they have identified as an appropriate charge for a service. Our fee may be greater; therefore, you may be responsible for any balance remaining after your insurance company has paid their portion of the bill.
Many insurance companies have benefit plans that state that they will cover up to 30 or 60 days per calendar year or a maximum limit on particular services per year. Your coverage may be different. You will need to know how many days you have already used up in your coverage period. You cannot rely on your insurance company to know the correct number remaining days or remaining benefits as other providers may not have submitted claims in order for the insurer to provide a more accurate account. It is important for you or your representative to deduct used day and claim amounts from the actual benefit to determine remaining coverage.
Example: Your insurance policy states that they will cover 100% of your hospital and 100% of your physician charges for 30 inpatient days per calendar year. You were hospitalized for 5 days at another hospital earlier in the year. You are hospitalized at The Johns Hopkins Hospital for 35 days. You are responsible for the hospital and professional fees for10 days.
If you speak with a representative at your insurance company who gives you benefit information different from the information that was provided to you by the Psychiatry Admissions staff, please notify us of the difference so that we can clarify the benefits with the payer.
As an inpatient of a psychiatry program, you will receive separate bills from the Hospital and from the Physicians.The Johns Hopkins Hospital bills for hospital and facility charges and The Johns Hopkins University submits bills for the physicians and professional fees. Both entities participate with Medicare (excluding most Advantage plans), Medical Assistance of Maryland, and various other health plans. They do not, however, participate with all health plan insurances. Insurance participation will be determined during the referral intake process.
Depending upon your insurance, you may not receive a bill at all, but instead receive an ‘explanation of benefits’ which will outline what your insurance was charged and what was paid on your behalf.
Please note that some insurers (i.e. Blue Cross, excluding Medigap and Federal BC secondary to Medicare) participate with The Johns Hopkins Hospital, but do not participate with The Johns Hopkins University. In this instance, you would be responsible for paying for the portion of your physician’s bill that your insurance plan does not cover and submitting claims to your insurer for possible reimbursement to you.
Your hospital bill covers the costs associated with your room and board, clinical care, and ancillaries.
Maryland is a non-DRG state and the State of Maryland and the Health Cost Review Commission controls the rates that hospitals are allowed to bill, which means there is no negotiating hospital charges. The rates can change at any time; however, our staff use the most current charges to determine the estimated cost for services.
Johns Hopkins Hospital averages the length of time that most patients are hospitalized for each service. Based on that figure, we can estimate your facility liability so that you can better prepare financially for hospitalization. This estimate does not include any additional services or procedures (such as labs or medications) nor does it include physician fees. Please note that this is just an approximation based on charges of patients who have been treated for similar services.
You will receive multiple bills for the care provided by the physicians as professional fees are billed on a daily basis. If more than one physician provides care, you may receive a separate bill from each physician. For example, a patient receiving electroconvulsive therapy (ECT) will receive a bill from their attending physician as well as the physician providing the ECT service.
Due to the fact that The Johns Hopkins Department of Psychiatry physicians do not participate with many health care insurers and healthcare managed organizations, you may be required to pay a deposit on the day of admission for any insurance plans the department does not participate with, as well as any services where there is no insurance coverage.
The hospital’s Medical Assistance Team assists hospital patients who do not have health insurance or have limited health insurance to apply for Medical Assistance. If you apply for and receive Medicaid we will bill them for your care. If you do not have health insurance and do not apply for Medicaid or are determined to be ineligible for Medicaid, you will be responsible for your entire bill.
To apply for Medicaid in Baltimore City, contact:
Baltimore City Department of Social Services
2000 North Broadway
Baltimore, MD 21213