Understanding Your Insurance

Health insurance helps with many of the financial burdens of illness or injury, but it usually does not cover the entire bill. Each time you visit Marcus Daly Memorial Hospital, you will be asked to furnish us with your current insurance information, including any secondary insurance or Medicare supplemental insurance that you carry. We can assist you by filing your claim with your insurance company, but only if you provide us with accurate insurance information in a timely manner. You are ultimately responsible for your account(s), so it is important to stay involved with your insurance company. You are expected to pay any deductible, co-pay, and/or coinsurance amounts, and any charges not covered under your insurance. If you have additional insurance information that has not been billed, please contact us at (406)363-3228.

In some cases, you may be referred to a specialist. Make sure to check whether or not the specialist accepts your current health insurance, so as to minimize personal responsibility for uncovered charges.

Commonly Asked Questions:

  1. How do I know what my insurance paid?

    You will receive a statement indicating that we billed your insurance company. After we receive payment from your insurance company, you will receive a statement from us indicating your remaining balance. Your insurance company should send you a Medicare Summary Notice (MSN) or an Explanation of Benefits (EOB). These documents explain how much your insurance paid and how much you are responsible for paying. You may be responsible for any co-payment, deductible, coinsurance, and services not covered. Your insurance carrier makes final decisions regarding payment of claims, so if you have any questions, do not hesitate to contact your insurance company’s customer service department. Their number is listed on your insurance card.

  2. What is a co-payment, deductible, and coinsurance?

    A co-payment is defined in your insurance policy as an amount that you must pay each time you seek medical services. Co-payments vary depending upon the insurance plan and type of service. For example, if you have a $100 ER co-pay, the $100 will be collected every time you are seen in the ER.

    A deductible is defined in your insurance policy as the amount that you must pay before benefits of your policy apply. Deductibles are usually met every year. For example, if you have a $1,000 deductible, this amount must be paid by you before insurance will start paying on claims.

    A coinsurance amount is defined in your insurance policy and is the split, usually in percentages, between the amount you owe and what your insurance will cover. For example, your insurance may cover 80% of the bill and you will be responsible for the remaining 20%.

    Your benefits are a contract between you and your insurance company. Therefore, if you have any questions regarding your plan, please call the number listed on your insurance card.

  3. Why does my insurance cover some bills and not cover others?

    Most plans do not provide 100% coverage. Since each plan is different, we encourage you to review your benefits with your insurance company.

  4. How do I know if my health plan requires a referral or pre-authorization?

    Many insurance companies require a referral from the primary care physician. Also, many medical services require authorization (approval) from the insurance company before you receive hospital services. You are responsible for complying with these requirements. If you are unsure of your specific plan's requirements, please see your insurance policy manual or contact your insurance carrier.

  5. How do I know if Marcus Daly Memorial Hospital participates in my insurance plan (“in-network”)?

    Marcus Daly Memorial Hospital participates in a number of insurance plans. Please contact the Business Office at (406)363-3228 or your insurance carrier to see if we are a preferred provider.

  6. Why did insurance deny the claim? The most common reasons include:
    • The service was not covered under your plan.
    • The service was out of your plan's network.
    • You were not covered by your plan at the time of services.
    • You did not provide the correct insurance information at the time of service.
  7. What can I do?
    • Provide us with complete and accurate address and insurance information at the time services are rendered.
    • Inform us of any changes to your address, phone number or insurance information.
    • Understand your health plan's coverage and requirements.
    • Call our Customer Service Team at (406)363-3228 if you have questions or concerns regarding paying for your account.