Billing and Insurance Information

Insurance Information

At St. Luke’s Cornwall Hospital, we are committed to assisting patients both with healthcare coverage and those who are uninsured, to navigate their health care services.  We are committed to helping people understand the best options available to pay for their medical care.

 

It is important to understand that benefits and coverage rules differ from insurance carrier to carrier, and plan to plan. It is critical therefore, for individuals to know and understand the specifics of their plan.

 

Any patient having inadequate insurance coverage, or no insurance coverage, will be assisted in obtaining more appropriate coverage when applicable or will be requested to make the appropriate deposits at the time services are rendered.  If you do not have insurance, we can assist you with determining your eligibility for free or low-cost insurance, as well as governmental assistance.  Our financial services counselors can also help assess if you may qualify for financial assistance.  See the below section on financial assistance.

 

St. Luke’s Cornwall Hospital is a participating hospital provider in various types of insurance carriers, including governmental, commercial and managed care organizations.  Failure to provide accurate and current insurance information, and the required authorizations when you are admitted could result in a reduction of benefits by your insurance company.  Our organization strongly recommends that patients read, question, and ultimately understand the provisions and policies of their individual plan, to reduce or eliminate potential financial penalties imposed by the insurance carriers for non-compliance of the plans rules and policies.

Medicare Part A & B
If you are age 65 or older, have End Stage Renal Diseases, or are permanently disabled receiving Social Security Disability Insurance, you may qualify for Medicare benefits. Medicare Part A provides benefits for inpatient hospitalizations, while Part B covers services such as observation hospital stays, ambulatory surgery, emergency services, physician services, and outpatient diagnostic testing. Your insurance card will indicate what coverage you are entitled to, along with the effective dates of coverage. Medicare Part A has pre- determined your copayment responsibility for each covered procedure or test performed on an outpatient basis in a hospital setting.

Medicaid
Medicaid is a state-run health care system for patients not covered by other healthcare insurance. Eligibility is based upon earnings, family size, and other criteria determined by social services. Anyone who believes he/she may be eligible to receive these benefits should apply at their local Department of Social Services. Patients may also find themselves enrolled in a managed care program or NYS Health Exchange plan.  Managed care programs often offer similar benefits to traditional Medicaid, but are subject to similar rules and regulations of managed care and HMO policies such as selecting a primary care physician, referrals and authorization requirements for services.

Patients enrolled in Medicaid managed care programs and the NYS Health Exchange are sometimes restricted as to which facility they may seek non emergent treatment. Medicaid beneficiaries should contact their local department of Social Services for more information regarding Medicaid benefits, coverage, and managed care options.

Billing Information
We at St. Luke’s Cornwall Hospital will work with each patient to obtain their most current and accurate insurance information so that a bill can be submitted timely to the insurance carrier. All insurances have time requirements that must be followed throughout the billing process, so it is the patient’s responsibility to ensure that current information is provided to the hospital at each visit, and any additional information requirements such as coordination of benefits, injury documentation, or other required questionnaires is provided upon request.

Hospital charges do not include physicians’ fees. Patients should be aware that they will receive separate bills for the professional services rendered which include emergency room physicians, radiologists for interpreting your x-ray procedures, anesthesiologists for the administration of anesthesia during surgery, pathologists for their services, your admitting physician and other physicians involved in consultation. You are responsible for providing insurance information to those other providers.

Important Information for Self Pay Patients
For those patients who are uninsured or underinsured, St. Luke’s Cornwall Hospital strives to provide information and assistance whenever possible to ensure that patients may gain access to or extend their coverage. Please speak to a hospital representative at the time of registration in order to get more information on potential assistance available.

St. Luke’s Cornwall Hospital is the first local hospital to provide discounted rates for self-pay patients, just as all hospitals provide discounts for insurance companies. Current self-pay rates are equal to the most current Medicare rates, as published by CMS.

Financial Assistance
As a not-for-profit hospital, St. Luke's Cornwall Hospital is dedicated to our mission of providing quality health care to the people of our community. In emergency situations, every patient is treated, regardless of the ability to pay. Care first is at the core of our SLCH philosophy. In non-emergency situations, we are committed to working with patients so that quality care can be provided.

For patients without health insurance or those that may not be able to pay in full for their health care, we offer a financial assistance program. SLCH provides financial aid to patients based on their income and needs. We also assist patients in obtaining health insurance if they qualify, and can work with patients to arrange a manageable payment plan. SLCH staff is available to give you the help and support you need to make your hospital experience a pleasant one.

It is important that you contact us if you cannot pay your hospital bill; federal and state laws require all hospitals to seek full payment on patient accounts. Clear communication is important to this process; if we are not notified of a financial issue, your unpaid bills may be turned over to a collection agency, which could affect your credit rating.
In addition to charging our self pay patients at our Medicare rates, SLCH offers a discount of 100% for anyone earning less than 200% of the Federal Poverty Guidelines and a 50% discount for anyone earning between 200% and 300%.


For more information, please contact our Patient Accounts Department at (845) 458-4900. Your account will be handled with confidentiality and courtesy by our staff of professionals.

Applying For Financial Assistance
Patients must complete the St. Luke's Cornwall Hospital issued application. Patients must provide required proof of identity and income. Financial Assistance is handled on a case-by- case basis.
Forms of documentation that can be used to support your Financial Assistance Application are as follows:
 - Most recent W2 and/or tax returns
 - Pension letters
 - Social Security Determination Letter
 - 3 months of most recent pay stubs/wages
 - Unemployment compensation statement
 - 3 months of Bank Statements
 - Notarized attestation letter/letter of support explaining income, support, and/or current financial situation if other proof of income is not available may be accepted.

 

Pricing Transparency as required by Center for Medicare and Medicaid Services (CMS)  1.1.19
St. Luke’s Cornwall Hospital is committed to being transparent about our charges. Charges are the dollar amount a provider sets for services before negotiating any discounts.  The information on this site contains the charges for all services and items provided by the hospital. The charges are uniform for all patients served by the hospital.  Also included are average charges by Diagnosis-Related groups (DRG) as recommended by CMS.

CHARGEMASTER 2019 - FINAL.csv | DRG INFO - FINAL.csv


 

Please note, the hospital charges do not reflect what a third-party payer and /or an individual patient would be required to pay for a specific service. Your out-of-pocket expenses, if any, will depend on one or more of the following:

• The actual patient care services received
• The terms of your insurance coverage, your specific health benefits policy including your deductible, co-insurance, co-payment and the limit of out-of-pocket expense requirements.
• Your eligibility for financial assistance.

 

For a fuller understanding of your estimated out-of-pocket expenses for a specific service, you should contact your insurer or the hospital’s Pre- Access Department at 845-458-4000. 

Downloadable Links:
To view the SLCH Financial Assistance Policy, please click here: LD 1415 Financial Assistance (501R Compliant).pdf (English) | LD 1415 Financial Assistance (501R Compliant) Spanish.pdf
To download the application, please click here: 2288 Financial Assistance Application.pdf (English) |2288S Financial Assistance Application Spanish.pdf

To view the Plain Language Summary of the Financial Assistance Policy, please click here: 3357 SLCH Plain Language Summary FAP.pdf (English)  | SLCH Plain Language Summary Spanish Translation.pdf
To view the Billing and Collection Policy, please click here: CD-008 Billing and Collection Policy.pdf (English) |CD-008 Billing and Collection Policy Spanish.pdf

To view the list of Health Plans Accepted at St. Luke's Cornwall Hospital, please click here: Participating Ins Plans Accepted At SLCH (2019.02.07).pdf