Presented by: Linda Heady, MBA Insurance and Billing Coordinator

25
Presented by: Linda Heady, MBA Insurance and Billing Coordinator

description

Presented by: Linda Heady, MBA Insurance and Billing Coordinator. Things you should know about the US Health Care System:. The system is privately funded, not government sponsored or socialized Payment is the responsibility of the individual, with or without health insurance - PowerPoint PPT Presentation

Transcript of Presented by: Linda Heady, MBA Insurance and Billing Coordinator

Page 1: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

Presented by: Linda Heady, MBAInsurance and Billing Coordinator

Page 2: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

Things you should know about the US Health Care System: The system is privately funded, not

government sponsored or socialized Payment is the responsibility of the

individual, with or without health insurance

Even with health insurance, medical treatment in the US can be very expensive. Without health insurance medical treatment can be extremely expensive

Before you visit a doctor, hospital or facility, always check to see if your insurance will be accepted.

Page 3: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

More info about US Health CareKeep copies of all bills and papers for

at least one year.You can ask a second doctor for an

opinion before getting treated Inform your doctor about the

conditions and medications you have had in the past

You can ask the doctor questions about your conditions and medications you have had in the past

Page 4: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

What do I do if I get sick?

Monday: 8:00am – 4:30pmTuesday: 8:00am – 4:30pmWednesday: 10:00am –4:30pmThursday: 8:00am – 4:30pmFriday: 8:00am – 4:30pm

Call 270.745.5641 for Appointment or Walk in Documentation of your visit can beprovided upon request.

Page 5: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

What if WKU Health Services is closed? If after 4:30pm or on Saturday or Sunday and

you can not wait until Monday to see a doctor:Go to:

Urgent Care: 8AM – 8PM everyday Phone: 270-781-3910 Cost is $50

Greenwood Clinic: 8AM-6PM Mon-Fri, 8AM-2PM Sat Phone: 270-843-5662 Cost is $50

Page 6: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

What to do in an EMERGENCY?

Call 911 Go to the Hospital:

Greenview Emergency Room (Hospital): Phone 270-793-1000

Medical Center Emergency Room (Hospital): Phone 270-745-1000

Cost is at least $250 or more depending on the number of services required.

Page 7: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

Welcome Lobby

Page 8: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

Laboratory

Page 9: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

Patient Exam Room

Page 10: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

X-Ray

Page 11: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

Services Provided Men’s and Women’s Health Wellness Examinations Immunizations Laboratory Tests Medications Birth Control/Contraceptives STD Testing Women – Yearly Exams Allergy injections X-Rays

Page 12: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

Leta WhitedPsychiatric Nurse

Practioner

Dr. Patricia BlewettMedical Director

Family Medicine, Board Certified

Yolanda ReedNurse Practioner

Dr. Allen ReddenInternal Medicine,

Board Certified

Our Providers

Page 13: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

I need to see the Doctorwhat should I do?

Call 745-5641 to schedule an appointment with WKU Health Services – if urgent, come directly to WKU Health Services.

At appointment time, please bring a copy of your insurance card and photo identification.

Page 14: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

Academic Health Plans (AHP)

Student Health Insurance – Major Medical Insurance Plan $739 per semester health insurance fee

pays for insurance coverage from August 1, 2013 until December 31, 2013.

You will be charged $739 again in January for Spring 2014 Semester.

Page 15: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

Academic Health Plans You will receive an insurance card:

Page 16: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

Insurance Terms

Deductible – Dollar ($) amount you will need to pay before the insurance will pay.

Co-Payment (Copay) – Specific dollar ($) amount you must pay at the time of service.

Co-Insurance - Dollar ($) amount based on a percentage you must pay for services.

Page 17: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

Insurance pays 100% at WKU Health Services Preventative Care

Annual Examinations Tobacco use screening and cessation Depression screening for adults

Well women Exams Contraceptives/Birth control Nexplanon Contraceptive Placement

Immunizations/Vaccines Hepatitis, HPV, Flu, MMR, Meningitis, Pneumonia, Tdap,

Varicella

Page 18: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

WKU Health Services

In-Network Provider(First Health)

Out-of-NetworkProvider(First Health)

Physician Office

You pay $0AHP pays 100%

You pay $50 You pay $50 AHP pays 60% and you pay 40%

Physician Office

Page 19: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

In-Network Provider(First Health)

Out-of-NetworkProvider(First Health)

Urgent Care You pay $50 AHP pays 100%

You pay $50 AHP pays 60% and you pay 40%

Emergency Room (Hospital)

You pay $250AHP pays 100%

You pay $250AHP pays 60% - you pay 40%

Urgent Care or Emergency Room

Page 20: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

WKU Health Services IN NETWORKFirst Health(If a complex Lab, Health Services sends it to QUEST)

OUT-OF-NETWORKFirst Health

You pay $0AHP pays 100%Some of these include: UA, Glucose, CBC, Flu, Strep, Mono, Pregnancy Test, Wet Prep Stain, prep for fungal elements on skin

$50 copayAHP pays 100%Some of these include: Pap Smears, Lipid Panel, Liver Tests, Comp Metabolic Panel, Gonorrhea & Chlamydia testing

$50 copayAHP pays 60% - you pay 40%

Laboratory

Page 21: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

IN NETWORKFirst Health

OUT-OF-NETWORKFirst Health

Hospital Expenses AHP pays 80% of Preferred Allowance (You must first pay $300 deductible, then 20%)

60% of Usual and Customary Charges(You must first pay $600 deductible, then 20%)

Surgery AHP pays 80% of Preferred Allowance (You must first pay $300 deductible, then 20%)

60% of Usual and Customary Charges(You must first pay $600 deductible, then 20%)

Hospital and Surgery Coverage

Page 22: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

WKU Health Services

IN NETWORKFirst Health

Prescription Drugs Some medications available

You pay $15 for genericYou pay $30 for brand name

Immunizations and Prescription Drugs

Page 23: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

What happens after you go to the doctor?

You will receive an EOB (Explanation of Benefits) from Klais

Page 24: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

Dental and Vision Care

ON CAMPUS - Dental Hygiene Program operates a clinic on the 2nd floor of Academic Complex – Room 223

Services offered include: X-Rays, Sealants and Prophylaxis (Cleaning)

Fee: $15 student, $20 non-student Call 745-2426 for appointment

If you need glasses or contacts, please call an eye doctor in the Bowling Green area.

If you have tooth/jaw pain, seek a dentist in the Bowling Green area.

Dental Insurance and Vision Discount Program is offered by Neace Lukens – call Wendy Skipworth at 393-6239

Page 25: Presented by: Linda Heady, MBA Insurance and Billing Coordinator

Need assistance?

Contact Linda Heady, Insurance & Billing Coordinator at 745-5034.

Call AHP at 888-308-7320 for assistance with AHP insurance questions.