Hailey Tran
Adventist Health hospitals and their affiliated hospitals charge for items and services using national industry-standard codes. They comply with federal and state pricing transparency regulations by providing a list of current standard charges. Adventist Health hospitals are contracted with major health plans, and patients are encouraged to confirm acceptance with their insurance company before receiving treatment. Adventist Health Portland, for example, is partnered with Oregon Health & Science University, while Adventist Health and Anthem Blue Cross of California have an agreement for healthcare services at 23 hospitals and over 300 clinics. Adventist Health does not currently accept Medicaid plans.
| Characteristics | Values |
|---|---|
| Adventist Health Hospitals' billing practices | Adventist Health and its affiliated hospitals charge for items and services provided to patients using national industry-standard codes, including CPT procedure and HCPCS codes. |
| Compliance with pricing transparency regulations | Adventist Health complies with federal and state pricing transparency regulations by providing a list of current standard charges in a machine-readable format. |
| Protection against surprise billing | Adventist Health hospitals follow state laws in California, Oregon, and Washington, protecting enrollees in state-regulated plans from surprise medical bills when receiving emergency services or scheduled care at an in-network facility but treated by an out-of-network provider. |
| Billing for out-of-network providers | Out-of-network providers may be permitted to bill patients for the difference between the plan-agreed amount and the full service charge (balance billing), which is often more than in-network costs. |
| Accepted insurance plans | Adventist Health hospitals accept various major health plans and insurance providers. However, specific plans may vary by location, and it is recommended to contact the hospital or insurance company to confirm coverage. |
| Medicare and Medicaid | Adventist Health hospitals accept Medicare payments, while Medicaid acceptance may vary, as indicated by Advent Health not accepting Medicaid plans. |
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What You'll Learn
- Adventist Health hospitals charge patients using national industry-standard codes
- Adventist Health hospitals comply with federal and state pricing transparency regulations
- Adventist Health hospitals offer discounted rates for uninsured patients
- Adventist Health Portland is contracted with major health plans
- Adventist Health does not accept Medicaid plans
Adventist Health hospitals charge patients using national industry-standard codes
Adventist Health hospitals and their affiliates charge for items and services provided to patients using national industry-standard codes, including CPT procedure and HCPCS codes. They comply with federal and state pricing transparency regulations by providing a list of current standard charges in a machine-readable format. However, the charges listed may not reflect the actual amounts paid by patients and insurers. The amounts paid are typically based on the type of care provided or the length of the hospital stay.
Adventist Health hospitals accept various forms of payment, including Medicare, Medicaid, and private insurance plans. For patients with Medicare, Medicaid, or private insurance, the payment amounts are determined by the government or the negotiated contract rates, respectively. For uninsured patients, hospital charges are discounted to the amounts generally paid by Medicare and private insurance payers, as outlined in the Uninsured Discount Policy. Additionally, Adventist Health offers financial assistance for patients who meet specific income criteria based on federal guidelines.
It is important to note that services provided by physicians are typically billed separately from hospital charges. These separate charges are common for emergency room visits, radiology tests, or surgical services. Patients are encouraged to contact their physicians directly for information regarding reimbursement and their financial responsibilities.
In states like California, Oregon, and Washington, enrollees in state-regulated plans are protected from surprise medical bills when receiving emergency services from an out-of-network provider or facility. In such cases, providers cannot bill consumers more than their in-network cost-sharing amounts. Adventist Health also provides resources for patients to understand their rights and protections against surprise medical bills, with specific phone numbers for enforcement issues related to California-regulated and federally regulated plans.
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Adventist Health hospitals comply with federal and state pricing transparency regulations
Adventist Health hospitals and their affiliated hospitals charge for items and services provided to patients using national industry-standard codes, including approved CPT procedure and HCPCS codes. They comply with all federal and state pricing transparency regulations by making available a list of current standard charges in a machine-readable format.
Adventist Health's California facilities are required to post certain charge information on the State of California, Office of State Health Planning Department (OSHPD) website. However, the state does not allow this information to be updated as rates change throughout the year. For this reason, Adventist Health provides a link to the most current information.
Adventist Health hospitals are committed to providing transparency to their patients. They comply with the Hospital Price Transparency Rule, which requires hospitals to publicly post five different "standard charges": gross charges, payer-specific negotiated rates, de-identified minimum and maximum negotiated rates, and discounted cash prices. Additionally, they provide patients with an out-of-pocket cost estimator tool or payer-specific negotiated rates for at least 300 shoppable services.
Adventist Health also complies with the No Surprises Act, which protects patients from surprise medical bills. For patients in California, Oregon, and Washington, state law protects enrollees in state-regulated plans from surprise bills when they receive emergency services from a doctor or hospital that is not contracted with their health plan. In these cases, providers cannot bill consumers more than their in-network cost-sharing amount.
Adventist Health Portland, for example, is partnered with Oregon Health & Science University, offering high-value and high-quality care. They work with major health plans and are committed to helping patients understand their options. Patients with billing questions or concerns about compliance with federal and state regulations can contact Adventist Health directly.
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Adventist Health hospitals offer discounted rates for uninsured patients
Adventist Health hospitals provide discounted rates for uninsured patients, charging them the amounts generally paid by Medicare and private insurance payers. These discounts are outlined in the Uninsured Discount Policy. However, it's important to note that services provided by physicians are typically billed separately and may not be included in the hospital's list of standard charges. Patients are advised to contact their physician for details on reimbursement and their financial responsibility.
In states like California, Oregon, and Washington, enrollees in state-regulated plans are protected from surprise medical bills. If an enrollee receives scheduled care or emergency services at an in-network facility, such as a hospital or lab, but services are provided by an out-of-network provider, the patient is only responsible for paying their share of the cost, including copayments, coinsurance, and deductibles. Uninsured individuals must be provided with a written estimate of the expected charges at the time of service.
Adventist Health also offers financial assistance for patients whose income meets federal guidelines. Medicaid beneficiaries may have a small share of costs depending on their income level. For patients with private insurance plans, the responsibility amounts are determined by the terms of their plan, whether purchased through an employer or directly.
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Adventist Health Portland is contracted with major health plans
Adventist Health and its affiliated hospitals charge for items and services provided to patients using national industry-standard codes, including CPT and HCPCS codes. They comply with federal and state pricing transparency regulations by making a list of current standard charges available in a machine-readable format. Adventist Health Portland accepts insurance and patients are responsible for co-pays, deductibles, and any remaining balance that their insurance requires them to pay.
For patients in California, Oregon, and Washington, state law protects enrollees in state-regulated plans from surprise medical bills when they receive emergency services from an out-of-network provider or hospital. In these cases, providers cannot bill consumers more than their in-network cost-sharing amount. Additionally, for uninsured individuals, hospitals must provide a written estimate of the expected charges.
Adventist Health Portland is committed to providing financial assistance and ensuring patients have access to high-quality care. If patients have questions about their health plan or insurance coverage, they can contact Adventist Health Portland's patient service representatives or the hospital directly.
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Adventist Health does not accept Medicaid plans
While Adventist Health serves patients with Medicaid in California (Medi-Cal), Hawaii (Med-QUEST), and Oregon (Oregon Health Plan), it is important to note that not all Adventist Health hospitals and affiliated clinics accept Medicaid plans. For instance, AdventHealth Primary Care+ does not currently accept any Medicaid plans.
Adventist Health complies with federal and state pricing transparency regulations and provides a list of current standard charges. However, it is always recommended that patients with Medicaid plans contact their specific Adventist Health hospital or clinic to confirm whether their plan is accepted. This is because each Adventist Health facility has different contracted health plans, and Medicaid acceptance may vary by region and hospital.
In states like California, Oregon, and Washington, enrollees in state-regulated plans are protected by state law from surprise medical bills when receiving care at an in-network facility, such as a hospital or imaging center, but services are provided by an out-of-network provider. In such cases, providers cannot bill consumers more than their in-network cost-sharing amount. Adventist Health also provides protections against surprise medical bills, where patients have rights against balance billing, which is when an out-of-network provider bills for the difference between the plan-agreed amount and the full service charge.
To ensure clarity and avoid unexpected charges, patients with Medicaid plans should proactively verify their coverage and understand their rights and protections. This includes checking with their specific Adventist Health location and staying updated with any changes in Medicaid benefits and eligibility requirements, especially as the COVID-19 public health emergency comes to an end. By taking these proactive steps, patients can make informed decisions about their healthcare choices and avoid unexpected financial burdens.
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Frequently asked questions
Adventist Health hospitals and clinics are contracted with several major health plans. Patients are advised to check with their insurance company and the hospital to confirm acceptance before receiving treatment.
Adventist Health hospitals offer discounted rates to uninsured patients. These discounts are described by the Uninsured Discount Policy.
If you believe you've been wrongly billed, you may contact (888) 466-2219 for enforcement issues related to California-regulated plans or (800) 985-3059 for federally regulated plans.
As of January 2, 2024, AdventHealth Primary Care+ does not accept any Medicaid plans.
