Billing Questions

Mena Regional Health System seldom – if ever – is paid the full amount of billed charges. The hospital negotiates payment rates with every major insurance company that provides coverage to residents in our community. As part of that negotiation, the insurance company typically establishes an “allowable” rate for each item or service and then establishes a discount from that “allowable” rate that they pay, minus any deductibles, coinsurance, and co-pays that the insurance company deems the patient’s responsibility. This “allowable” rate typically falls well below hospital charges.

If the insurance company refuses to contract with the hospital, or if the hospital is unable to negotiate a satisfactory contract with the insurance company, MRHS may be considered out-of-network with that plan. The insurance company may then chose not to pay for the services you receive at an out-of-network facility, increasing your out-of-pocket expenses.

It is likely that your insurance company has negotiated different payment rates with each hospital under contract.

Deductibles vary by insurance company and reflect the plan you or your employer selected and the premium paid for that coverage. Lower deductible plans typically have a higher monthly premium, while higher deductible plans have a lower premium. The deductible is the amount you will pay each year before you receive benefits from your insurance company.

Established by your insurance company and plan, coinsurance is a percentage of the “allowable charge” you will pay after you have reached your deductible. Also established by your insurance company or pay, co-pays are a flat fee you pay for a health care service. Co-pays can take effect either before or after your deductible has been met and may not apply to all services.

Information about your deductibles, coinsurance, and copayments is available from your insurance company or employer.

Medicaid pays all hospitals based on the same fee schedule. You can view fee schedules by visiting the Arkansas Medicaid website.

Medicare payments are based on a predetermined, fixed amount. The payment amount for a particular service is based on the classification system of that service. If you have a supplemental plan, it will cover some or all of your deductible, coinsurance, and co-pays. You will need a separate Medicare Part D plan to secure insurance coverage for drugs.

If you have enrolled in a “Medicare Advantage Plan,” you no longer have traditional Medicare. These “plans” are offered by private insurance companies and have different monthly premiums, deductibles, coinsurance, and co-pays. Some of these plans also include drug coverage.

Information about your deductibles, coinsurance, and co-pays is available from the insurance company that sold you the “Medicare Advantage Plan.”

Uninsured or underinsured patients should consult with our business office to determine their financial liability.