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 educated choice about where you choose to receive services and how those services will be paid.
The Psychiatry Admissions Office will attempt to verify and explain your insurance benefits. However, it is your responsibility to speak to your insurance company and understand your benefits. 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 representative. 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 may attempt to authorize your treatment with your insurance provider prior to your admission. This means that we will provide information to the insurance provider explaining the reason that treatment is needed. Insurance companies have criteria that they use to determine whether a condition meets ‘medical necessity’ for them to pay for 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. If this happens, you can choose to not use your insurance, but you would be responsible for all bills associated with the unauthorized treatment.
However, even if the insurance company authorizes treatment, 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 of treatment from your insurance company. Even if they said that they authorized treatment for 45 days, since your benefits only cover 30 days per year 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.
To Obtain Information Regarding Your Insurance
Consult the written information provided to you by your insurance company. Also, contact the insurance company by phone and ask specifically about your mental health/ psychiatric benefits. Telephone numbers for insurance benefit information is 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 Resource Department at the company where you purchased the policy. If you have an individual policy you may want to call the representative who sold you the policy.
It is important to verify with your insurance company if Johns Hopkins Hospital at the East Baltimore Campus, 600 N. Wolfe Street, (not Bayview) is covered at the full percentage or at a reduced percentage. Many times they will describe this as being ‘in’ 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 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 and customary” according to their fee scale. That is, the insurance company will pay what they have identified as a charge for a service. Our fee may be greater. 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. 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 of days that you have used. If their computers do not have the claims for all of your treatment, they could mistakenly think that you have days remaining when you do not. It is important for you or your representative to count how many days you have already used.
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 here for 35 days. You are responsible for the hospital and professional fees for those 10 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.
YOU WILL RECEIVE TWO BILLS: Physician and Hospital
As a patient at The Johns Hopkins Hospital Department of Psychiatry, you will receive separate bills from the Physicians and from the Hospital. The Johns Hopkins University submits bills for the physicians and professional fees. The Johns Hopkins Hospital bills for hospital and facility charges. The Johns Hopkins Hospital East Baltimore Campus and the Johns Hopkins University Physicians participate with Medicare, Medical Assistance of Maryland, and various other payers and managed care organizations. They do not, however, participate with all payers. Regulations also require us to bill for deductibles and co-payments, even for those insurances with which we participate.
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.
The Johns Hopkins Hospital may participate with a health plan, but The Johns Hopkins Physicians may not. In this instance, you would be responsible for paying for the portion of your physician’s bill that your insurance plan does not cover.
Your hospital bill covers the costs associated with your room and board and clinical care.
The State of Maryland and the Health Cost Review Commission controls the rates that hospitals are allowed to bill, which means that there is no negotiating hospital charges. The rates can change at any time which makes it difficult for us to estimate charges prior to admission.
Johns Hopkins Hospital averages the length of time that most patients are hospitalized on each service. Based on that figure, we can estimate a range of how much your bill might be so that you can better prepare financially for your hospitalization. This range will not include any additional services or procedures (such as labs or medications). It will also not include physician fees. Please note that this is just an approximation based on what other patients who have been treated on this service have been charged.
You will receive a bill for the care provided by the physicians you see while a patient at Johns Hopkins. If more than one physician gives you care, you may receive a 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 insurances, payers and managed care organizations, you will be required to pay a deposit on the day of admission for any insurance plan the department does not participate with, as well as any services where there is no insurance coverage.
Patients Who Do Not Have Health Insurance
The hospital Medical Assistance Team assists hospital patients who do not have health insurance apply for Maryland Medicaid. 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