Aurora Insurance & Claims

Insurance Overview

Having health insurance in can significantly reduce your financial obligations when choosing Aurora as your health care provider. The first time you register at an Aurora facility, whether it’s in person or by phone, we’ll ask for your health insurance information. Be sure to have your medical insurance card with you when you call to make an appointment. You can also bring your card with you to your first visit.

See our full list of insurance providers.

9 Important Insurance Facts

If You Have Insurance

Fact #1

Co-pays must be paid before you receive care at Aurora.

Fact #2

Your health insurance may or may not cover the full cost of your service. You’re responsible for any remaining balance left over after insurance has paid their share. If you’re covered by an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization), contact your insurance company to learn which services, locations, and doctors are covered by your plan.

Fact #3

Before your first appointment, we’ll need to know if your health insurance policy has certain requirements for things like referrals, prior authorizations and pre-determinations. If you’re unsure, contact your insurance provider.

Fact #4

If you’re covered by an HMO managed care plan, your insurance may restrict where you can receive care. If you receive services outside of your network, you may be responsible for those charges. Check with your insurance company to ensure your Aurora provider is in-network.

Fact #5

If your care is related to Worker’s Compensation or Occupational Health, it’s important to inform your health care provider. If you receive services in multiple departments or facilities, each of them should be informed of the nature of your care.

Fact #6

It’s your responsibility to keep us updated on any changes in your insurance plan. If you don’t let us know about your changes, you may be billed for the entire cost of services.

Fact #7

If you have an outstanding balance, you’ll be asked to make a payment or set up payment options before your next service.

If You Do Not Have Insurance

Fact #8

If you don’t have health insurance, you’ll be asked to make a deposit before your scheduled service. Deposits can range from $100 for services like office visits and physical therapy, to $1500 for services like surgery.

Fact #9

You’ll need to meet with an Aurora health insurance financial advocate before you receive services. They’ll help you learn about financial programs and discounts that could significantly reduce the cost of your care.

COBRA

If you were recently covered by insurance under a group health plan, you may be eligible to extend that coverage to assist you with your medical bills. Our financial advocates can help you find out if you qualify for COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage.

Medicare

Medicare is health care insurance coverage provided by the federal government. It’s mostly available to those 65 and older, although others may qualify in special circumstances. Medicare covers the cost of services and supplies that are considered medically necessary to diagnose or treat a disease or condition. Services like lab tests, surgeries, and doctor visits may all be covered by Medicare. 

Special Circumstances

In some cases, you doctor may order an item, service, or supply that’s either not covered by Medicare, or that’s not covered by Medicare in your particular situation. If that happens, your doctor will talk to you about your options. You’ll then be asked to read and sign a form stating that you may have to pay for the item, service, or supply out of pocket.

Prescription Drugs

Medicare Part D provides outpatient prescription drug coverage, and can be combined with Medicare Parts A & B to further reduce outpatient costs. If you’re sent a bill for the self-administered drugs you received in a doctor’s office, call your Medicare drug plan for more information about your financial responsibility. 

Pre-Authorization, Pre-Certification, Second Opinions & UCRs

Three important ways health insurance coverage can change.

Your health insurance can vary based on many different factors. The 3 most common ways insurance coverage can change include:

Pre-authorizations and pre-certifications: Many insurance companies require an approval, called pre-authorization or pre-certification, before your doctor can perform certain tests or admit you to the hospital. If your insurance provider needs a pre-authorization or pre-certification, you’ll have to request it yourself. Unfortunately, we can’t do this for you.

Second opinions: Some insurance companies ask you to get a second opinion from another doctor before they’ll agree to pay for certain surgical procedures. Contact your insurance company to get more specifics about second opinions.

UCRs: Many insurance companies have pre-set payment limits assigned to certain medical procedures. They base the cost of each procedure on what they consider to be “usual, customary and reasonable” (UCR). However, the insurance company’s ideas about cost are not always in line with the actual cost of care. If our fees differ from your insurance’s UCRs, you’re responsible for the amount not covered by insurance.

Filing a Claim

We’re happy to file most of your primary, secondary, and Medicare insurance claims for you. Here’s how it works:

Primary and secondary insurance claims

We’ll file all primary and most secondary insurance claims for you. To help us file on your behalf, you’ll need to fill out an Authorization to Release form the first time you see your health care provider (or whenever your health insurance changes). Remember, it’s your responsibility to make sure your insurance company has your most up-to-date billing and payment information.

Medicare claims

We’ll file all Medicare Part A, Medicare Part B, and supplemental insurance claims for you. Note that Medicare will send some claims to your supplemental insurance. Because of this, it’s important to notify Medicare of any changes in your supplemental insurance plan.

If Medicare is covering your claim, they’ll send payment directly to us. From there, you’ll receive an explanation of your Medicare benefits, included covered services, directly from Medicare.

Keep in mind that if you’re covered by more than one insurance plan, you can file claims with both of them. One plan will serve as your “primary” insurance, and the other will be your “secondary” insurance. In some cases, you can even use Medicare in addition to your primary and secondary insurance policies.

Next Steps

If you have additional questions about your health insurance coverage, speak with your employer or contact your insurance company.

If you’ve had a change in health insurance, have questions about COBRA, or want to know more about Medicare coverage, call us at 800-326-2250.

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