Billing and Financial Resource Center

The patient/guarantor of the account is the person who is financially responsible for payment. A guarantor may or may not be the policyholder of the insurance. In accordance with HIPAA privacy regulations, patients age 18 and over will be their own guarantor and receive their own billing statement. In accordance with state law, both parents are legally responsible for the cost of medical care for children under 18 years old.

For minor children of divorced or unwed parents, the parent with who brings the child in for care will be considered the responsible party and will receive all billing statements and letters. Any court-ordered financial arrangements need to be worked out between the parents of the children.

Aspirus will bill your insurance plan shortly after health care services have been provided. As a convenience to you, we will send you a billing statement after your insurance company has processed the claim and there is a balance due from you.

The first time a charge is processed by your insurance, a detailed description of the charge and the payment information will be on your statement. Each subsequent statement will only carry forward the amount you owe for that charge. However, you may request an itemized bill at any time.

Additional charges and payments to your original statement will appear on your monthly statement as they are posted to your account.Please retain your statements to help you track charges, payments, adjustments, and your balance.

Patients without health insurance may receive a discount.

It is important to understand what medical services are covered by your insurance policy. We encourage our patients to verify coverage with your insurance plan to ensure that Aspirus services are covered by your policy and to estimate what portion of the charges you will owe. 

Deductibles and co-payments are due at the time of service, and timely payment for non-covered services and other patient responsibility amounts is appreciated.  

Aspirus accepts and bills most insurance plans. Please review a list of the insurance companies and plans that work with us. The list, however, does not guarantee coverage.

You will need to verify your eligibility and confirm that your insurance plan will cover medical services performed at our hospitals, health centers and clinics.

If your insurance plan does not have a contractual agreement with us, you can still receive care at Aspirus. However, you will be financially responsible for the total charge and may be asked to sign a waiver before receiving services.

Aspirus does not bill health-sharing organizations, however you will be provided with an itemized bill for self-submission to your plan upon your request. 

It is important for you to know if your insurance requires preauthorization or precertification in order to ensure payment is made for your services. Please contact them to learn whether authorization is needed. If you are told certain requirements must be met, please inform your physician’s office at time of scheduling to avoid delays in processing your services and/or admission to the hospital. 

Aspirus is a not-for-profit organization and our fees are based on our cost to provide care in our communities. As part of our continued commitment to improving price transparency for consumers and empowering patients through better access to price information, Aspirus now offers Price Estimates for common services. Visit our Price Estimates page to learn more. 

To assist our customers in making an informed choice, Aspirus also provides a list of gross charges for each of our hospitals. Visit our Hospital Standard Charges page to learn more. 

Aspirus accepts Mastercard, Visa, Discover, American Express, Google pay and Apple pay. Checking accounts payments are available through our Interactive Voice Response (IVR) system in addition to calling our Financial Clearance team. Use MyAspirus to view your statements and make payments. Checks and money order payments by mail are also accepted.

          

Certain providers help with your medical care even though you may not meet them. Commonly, these are the doctors who read your lab results, x-rays and EKGs, among others.

Aspirus provides itemized detailed billing upon request. Please send us a message through your secure MyAspirus account or call our Financial Care Center at (800) 627-3570 7:00 a.m. – 4:30 p.m. CST Mon-Fri.

Aspirus applies payments to the oldest outstanding patient balance due at the time the payment is received.

In-Network or Participating is when your Aspirus provider is part of your health plan’s preferred network of physicians and healthcare facilities. The amount you pay is usually lower when you receive care from a participating provider. 

Out-of-Network or Non-Participating is when your Aspirus provider is not part of your health plan’s preferred network of physicians and healthcare facilities.  Your health plan may be designed without any preferred network.  Receiving care from an Out-of-Network healthcare provider can mean your insurance plan will not cover some or all the costs of service and you will be responsible for any unpaid balance.

Professional fee is a charge for the services of a healthcare provider such as a Physician, Nurse Practitioner or Physician Assistant.  It is separate and distinct from the Facility Fee.  Imaging tests commonly have Professional Fees since a radiologist reviews the images and provides his/her professional interpretation of the results.  Aspirus will bill you a Professional Fee when your provider is an Aspirus hospital or clinic employee or we have an agreement to manage his/her professional billing.  If your provider is independent with privileges to practice at Aspirus (such as providers from Radiology, ENT, GI or Surgical Associates), the provider will bill you separately for the Professional Fee.  

Facility Fee is a charge for the services of the Hospital or Clinic.  It is separate and distinct from the Professional Fee of the provider (such as a Physician, Nurse Practitioner or Physician Assistant).  Facility Fees represent the charges for the resources involved in providing care to you.  These resources may include the use of the room and associated utilities, nursing or clerical time, the services of non-physician staff members like imaging and lab technicians and supplies or equipment.  Facility Fees are typically itemized and individually charged on bills that you receive, but Facility Fees may be bundled together for the purpose of your estimate.

Coverage Determination is the decision made by your insurer that a medical service is covered under the terms of your policy with them, and what amount you and your insurer will each have to pay for a medical service.  Not all plans pay for the same services in the same way. Aspirus is not responsible for the Coverage Determination made by your insurer.  If your insurer does not pay for any or all of the cost of the medical services you receive, you will remain personally liable for the unpaid balance of those services.  It is your responsibility as the plan member to challenge or appeal a Coverage Determination. 

Deductible is the dollar amount you must pay toward your covered healthcare expenses before your insurance plan begins to pay its share.

Copay (or Copayment) is the fixed dollar amount of your covered healthcare expenses  for which you are responsible. This is usually a flat dollar amount based on a specific type of service.

Coinsurance is the share of your covered healthcare expenses that you are responsible for paying after your deductible is met.  This is usually a percentage of the covered fees.

Out-of-Pocket Maximum is the most you could have to pay on your own for your covered healthcare expenses. This includes your coinsurance and deductible. Afterwards, your insurance plan is expected to pay 100% of the costs of your covered healthcare expenses.

Third-party coverage is when a third-party payer provides benefits and may pay for covered medical expenses for an insurance recipient or designated beneficiary. This includes payment for medical expenses owed to a health care provider or to the insured patient for reimbursement when the insured patient incurs covered out-of-pocket expenses. Third-party payers can be either private or public entities, such as health insurance company or Medicare or Medicaid agency.

Uninsured is a term Aspirus uses to identify patients registered as self-pay and who have no third-party coverage, benefits, or rights of reimbursement relative to the account or charges for services rendered by an Aspirus entity or provider. If a patient chooses to not provide insurance information, bill a third-party coverage, or seek the benefit of a right of reimbursement, the patient shall not meet the definition of Uninsured for purposes of our policy. In addition, deductibles, co-pays, or other balances that are not covered or reimbursed by a payor shall not render the patient Uninsured.

Uninsured Discount Program reduction is the amount Aspirus will reduce a patient’s bill by if the patient is uninsured and does not have third-party coverage.

WISCONSIN: access.wisconsin.gov 

MICHIGAN: mibridges.michigan.gov