Insurance

Mendocino Coast District Hospital, in best effort, attempts to contract with as many insurance plans as possible. As a courtesy, we are happy to bill your insurance directly for services provided by MCDH. Because each insurance plan has different coverage allowances and limitations, payment of services provided are never guaranteed and are subject to the allowances and limitations specific to the plan being billed.

Healthcare expenses are often unexpected or may seem overwhelming as a medical condition is discovered. Mendocino Coast District Hospital’s Financial Counselor is committed to assisting patients with questions about insurance coverage and financial assistance programs. To meet with a Financial Counselor, you may contact them directly at (707)961-4684 or financialcounseling@mcdh.net.
Here are some of the plans that Mendocino Coast District Hospital has a contract with:

Anthem Blue Cross
Blue Shield of California
Cigna
HealthNet
Humana
Interplan Network
Medicare
Medi-Cal
Multiplan
Partnership HealthPlans of California
TriCare West and TriCare for Life
United Healthcare
United Healthcare Medicare Advantage

Please note that this is list is subject to change and although Mendocino Coast District Hospital  has a contract with an insurance company, this does not guarantee any specific plan is considered a participating/preferred provider.

If you have questions or concerns about your insurance plan being a participating or preferred provider with Mendocino Coast District Hospital and detailed benefit or coverage questions, it is best to contact your insurance directly.

Understanding your Bill

Your bill will vary depending on the services provided by Mendocino Coast District Hospital.  We provide a variety of services and there will be an itemized charge for each service, supply, and/or medication provided. Estimates can be provided before or at the time of service for non-emergent services.

If you have insurance, we will submit a bill to your insurance on your behalf.  When they have processed this, they will make payment directly to Mendocino Coast District Hospital and will send you an Explanation of Benefits (EOB) explaining how they processed your claim.  If you are concerned with how your insurance processed the claim, you should contact them directly for a more detailed explanation.  However, our Patient Accounting Staff is available for assistance if you have questions in regards to the charges.

A bill will be sent to you once your out of pocket responsibility has been determined.  Your bill will not include itemized charges, but an itemized bill is available upon request.  If you would like to obtain an itemized bill, you may contact Patient Accounting at (707)961-4700.

You may receive separate bills for certain tests or procedures performed while seen at Mendocino Coast District Hospital. These bills are for professional services rendered by other providers or physicians. Pathologists, emergency department physicians, radiologists, cardiologists, anesthesiologists and other specialists perform these services and are required to submit separate bills. If you have questions about these, please call the number printed on the statement you receive from them.

Patient Price Information List

[Download Hospital Chargemaster in Machine Readable CSV Format]

Disclaimer: Mendocino Coast District Hospital determines its standard charges for patient items and services through the use of a chargemaster system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for items and services provided at the Hospital. The chargemaster is similar in concept to the manufacturer’s suggested retail price (“MSRP”) on a particular product or good. The charges listed provide only a general starting point in determining the potential costs of an individual patient’s care at the Hospital. This list does not reflect the actual out-of-pocket costs that may be paid by a patient for any particular service, it is not binding, and the actual charges for items and services may vary.

Many factors may influence the actual cost of an item or service, including insurance coverage, rates negotiated with payors, and so on. Government payors, such as Medicare and Medicaid for example, do not pay the chargemaster rates, but rather have their own set rates that hospitals are obligated to accept. Commercial insurance payments are based on contract negotiations with payors and may or may not reflect the standard charges. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise. Moreover, the foregoing list of charges for services only includes charges from the Hospital. It does not reflect the charges for physicians, such as the surgeon, anesthesiologist, radiologist, pathologist, or other physician specialists or providers who may be involved in providing particular services to a patient. These charges are billed separately.

Individuals with questions about their out-of-pocket costs of service and other financial information should contact the hospital or consider contacting their insurers for further information.

Billing Help

Mendocino Coast District Hospital is here to help with all of your health care needs, from the time you enter our hospital through billing assistance.

Our dedication to quality patient care and patient satisfaction are our highest priorities.  If you are in need of additional assistance you may contact our Patient Accounting Department at:

Monday – Friday
8:00am – 5:00pm
700 River Dr.
Fort Bragg, CA 95437
(707)961-4700

Financial Assistance

Mendocino Coast District Hospital offers a variety of Financial Assistance options and are committed to providing compassionate, high-quality care to our community.  If you do not have health insurance, are underinsured, or have experienced high medical expenses, our Financial Counselor is here to help you find and access government or private programs that may help you pay for health care.

We have a Financial Counselor available to personally assist you with completing applications for Medi-Cal, or for one of our Financial Assistance Programs.

If you are in need of personal assistance, appointments are available.  You may contact our Financial Counselor at:

Monday – Friday
8:00am – 5:00pm
700 River Dr.
Fort Bragg, CA 95437
(707) 961-4684
financialcounseling@mcdh.net

(link to MCDH Financial Assistance Application)
(link to Summary of MCDH Financial Assistance Programs)

Financial Assistance Resources

Government Program Resources for the Uninsured

The Foundation for Health Coverage Education (FHCE) offers a unique online tool and call center to help you find health coverage. Answer five simple questions about your household and instantly receive a customized profile with information on public and private health plans for which family members in your household may qualify. The tool can be accessed by clicking on the link below.

State Specific Resources for California

FHCE California Tools & Resources
Covered California – Marketplace for individuals and small businesses to find affordable coverage (Affordable Care Act)
Finding Healthcare Coverage in California Booklet – English Spanish
Medi-Cal Application – English Spanish
COBRA: Your Ultimate Health Coverage Guide

Billing FAQ (Frequently Asked Questions)

Provided below is a list of Frequently Asked Questions. For answers to your specific billing questions, please contact our Patient Accounting Department at (707)961-4700 for assistance.

  1. Who will bill my insurance?

A representative of MCDH may provide you with an estimate of your total charges prior to your visit, during your visit, or before you are discharged from our hospital. You may be asked to pay your co-payment, deductible and/or co-insurance at that time. We will then bill the health insurance company on your behalf. If the bill is unpaid because the insurance company states you no longer have health insurance coverage, we will send you a bill. If you have changed insurance companies, contact us as soon as possible so we may change the information on file and bill the account correctly. If your health insurance coverage is through Medi-Cal, an HMO or Workers Compensation, you may not receive a bill. If your bill is denied or your HMO determines that a portion of the bill is a patient responsibility, you will receive a bill. If you made payment on or before the date of service based on an estimate provided that was too high, a refund will be issued once your insurance has made payment and if you do not have any other outstanding balances due.

  1. Why am I being asked for my insurance information again? My doctor should already have it.

In order to successfully bill your insurance, it is important that we verify your insurance at each visit.  Additionally, physicians are not employed by the hospital. Physicians keep their own patient information because your health insurance coverage may be different for a physician than it is for hospital services. For these reasons, physicians and the hospitals keep separate health insurance information.

  1. I was in the hospital several weeks ago, why haven’t I received a bill?

For patients with health insurance: once your insurance company has been billed and has responded to us, we determine how much you may owe and bill you. Depending on how quickly the insurance company processes the bill, it may take 3 to 12 weeks for you to receive a bill. Other causes for delays in receiving your billing statement can be due to wrong address, or a recent move, therefore, it is important to contact the billing office to update us with your current address and personal information.

  1. I received a billing statement, but all it shows are total charges. Can I ask for an itemized bill?

The amount that is due from the patient is rarely based on the total charges for the account, so the itemized bill may be of little use to you. Most insurance companies pay at a reduced rate from the total charges. The patient’s amount is then based on this reduced rate. If you would like a copy of an itemized statement, please contact Patient Accounting at (707) 961-4700.

  1. Why did my billing statement have an adjustment amount?

“Adjustment” (discount) refers to the portion of your bill that your hospital or doctor has agreed not to charge. Insurance companies pay hospital charges at discounted rate. The amount of the discount is specific to each insurance company. When the insurance company pays their portion, the discounted amount (adjustment) is taken off to show the true amount due from the patient (co-insurance). For example, a hospital may charge $10,000 for a surgery that your insurance has agreed to only pay $2,500. Of that $2,500, the patient would have to pay $500 if the patient’s responsibility is 20%. After the insurance pays $2,000 and patient pays $500, the remaining $7,500 would be the adjustment.

  1. I have coverage under both my insurance and my husband’s. Since the deductible is less under his insurance, can you bill his insurance and not mine?

Unfortunately, under a provision called coordination of benefits, the hospital is required to bill the insurance that would be considered primary for you. Any health insurance for which you are the primary holder must be billed before any other health insurance.

  1. Can I find out how much my emergency room service will cost and if my medical insurance will cover the visit before seeing the doctor?

When someone comes to the Emergency Room, it is implied that they have a medical emergency. Specific Federal regulations (EMTALA) require that Emergency Room Clinicians first see the patient before we can discuss any financial questions. We understand that this restriction can be frustrating. However, the regulations are there to ensure everyone who comes to an Emergency Room will be seen regardless of their ability to pay. Once you have been medically evaluated and stabilized, you will be asked to pay your co-payment, deductible, co-insurance or deposit by a Patient Registration representative.

  1. After my hospital stay, I received separate bills from the hospital and physicians. Why did I receive so many bills?

Please note that you may receive more than one bill for services received at the hospital. Physician charges, may include bills for Radiologists, Anesthesiologists, Cardiologists, and Pathologists, and will be billed separately. Physicians are independent of the hospital and bill for their services separately. In addition, they are required to bill on a different form than the hospital and sometimes even bill different offices at your insurance company. In the State of California, if you do not have insurance or have high medical costs you may also qualify for a discount on your physician’s bill from your emergency room physician. For more information please contact your physician.

  1. When will my insurance company settle my account?

While each insurance company is different, we generally expect full payment from your insurance company within 45 days of billing. If your insurance company does not pay the bill within 45 days, we may send you a notification of their non-payment and request that you contact them to send the payment.

  1. How will I know how much I will need to pay?

A representative from Patient Registration may provide you with a “Patient Out of Pocket Financial Estimate”. This will be a “best estimate” based on the information regarding your procedure(s) provided by you, your physician and/or clinical staff and the billing codes. If you are insured, it will also be based on your insurance coverage and our contract with your insurance company. Once we receive a payment or denial from your insurance company, you will receive a statement showing the amount that is due from you. This amount should be the same amount noted on the Explanation of Benefits (EOB) you receive from your insurance company. This amount is due when you receive the statement. If you have questions, please contact your insurance company or our Customer Service number located on your billing statement. Please note that if your insurance company fails to make any payment on your account, we may ask for full payment from you.

  1. How may I make a payment?

MCDH accepts cash, check, money order, VISA, MasterCard, personal checks. If additional methods of payment are required, please contact Patient Accounting at (707)961-4700 and we will work with you to facilitate timely payment.

  1. Where can I find answers to questions about Medicare?

Go to www.medicare.gov for more information on Medicare.

  1. What is an Advance Beneficiary Notice (ABN)?

An Advance Beneficiary Notice (ABN) is a written notice from either the physicians, providers or suppliers, before they provide a service or item to you, notifying you:

That Medicare may deny payment for the specific service or item
The reason the physician, provider or supplier expects Medicare to deny the payment
That you may be personally and fully responsible for payment if Medicare denies payment.

An ABN also gives you the opportunity to refuse to receive the service or item.  Because Mendocino Coast District Hospital is a Medicare provider, they are required to issue an ABN if there is reasonable belief that Medicare will not make payment.

  1. What if I cannot pay or I do not have Insurance?

If you need help paying your bill, you may qualify for a government-sponsored program or our Discount Payment Program that may cover some or all of your balance. To determine if you qualify for financial assistance, please contact our Patient Financial Counselor at (707)961-4684 and they will be happy to assist you with the application process should you choose to apply.

  1. What if I am unable to make the full payment? Can I set up a payment plan?

Yes. If you would like to set up a payment plan, please contact Patient Accounting at (707)961-4700 or our Financial Counselor at (707)961-4684.

Please mail payments to:

MCDH Billing Office
700 River Drive
Fort Bragg, CA 95437

707-961-4700 or 707-961-4684