Welcome To Rio Grande Hospital and Clinics!

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Welcome to Rio Grande Hospital and Clinics!

Introduction:

Rio Grande Hospitals (RGH) and Clinics are dedicated to serving the health care needs of all the people
within our communities and services areas. We understand that the practice of medical billing can be
confusing and overwhelming, and that during an illness or injury is not the right time to be concerned
about a hospital bill. This brochure has been developed to provide information about the processing of
your medical bills from RGH and Clinics.

Financial Assistance:

RGH will provide financial assistance for those who qualify. RGH’s Financial Assistance Policy (FAP) is
available for those who are uninsured and underinsured. For an application please call 719-657-2510,
or visit our website: rio-grande-hospital.org, click on the patient center tab, then select Financial
Assistance. No patient will be denied medically necessary treatment regardless of their ability to pay.

Patient Responsibility:

You are ultimately responsible for all payment obligations arising out of your treatment or care and
guarantee payment for these services. You are responsible for deductibles, co-payments, co-insurance
amounts or any other patient responsibility indicated by the insurance carrier or our FAP. It is your
responsibility to verify that your insurance company pays on a timely manner. If your insurance carrier
does not pay for your services within a responsible time, you will be responsible for those charges.

Prompt Pay:

RGH also offers a 20% prompt pay discount to anyone who is uninsured (for those for whom we do not
file a claim to an insurance company), as long as payment is received in full on the date of service or
within thirty (30) days of receipt of your first billing statement. Those who qualify for the prompt pay
discount do not qualify for a payment arrangement.

Collections:

Whether you are insured or are self-pay, payment of any account balance is due to our billing office,
First Party Receivable (FPRS) in Greeley, Colorado within thirty (30) days of receipt of your billing
statement. If you need to make payment arrangements, you may contact FPRS to set up a mutually
agreeable payment plan. If any balance on your account is over 120 days past due, without a payment
plan, your account will be in default and may be referred to our collection agency, Professional Finance
Company (PFC), in Greeley, Colorado.

Registration:
The first step in receiving services at RGH and Clinics is the registration process. At your initial visit you
will be asked to complete the Patient Information and the Notice of Privacy Practice forms. You will also
be required to provide your insurance card(s) and a photo ID to be copied and scanned into our system.
Patients with Medicare or Medicare Replacement plan coverage will be asked to complete the Medicare
Secondary Payer form (required by law). At every visit to RGH you will be asked to verify your personal
and insurance information verbally. If you have any changes to this information be sure to provide the
changes as soon as possible. Patients are also required to sign the Consent for Medical Treatment form
at each visit for outpatient services. Minors will be required to have a parent or legal guardian present
to sign the Consent for Medical Treatment.

Processing Bills:

RGH and Clinics contracts with most major insurance plans, including Medicare and Medicaid. If you
have health insurance you will be asked to provide a copy of your insurance Identification card(s), which
will be used to verify eligibility with that insurance. Having the correct information on file from the start
is imperative for filing your claims to the correct insurance in a timely manner and contacting you with
pertinent information about your health care.

As a courtesy, RGH will attempt to bill your insurance carrier when the claim is complete. Some
insurance plans may have special requirements such as Preauthorization for certain tests, procedures,
emergency room visits or Hospital stays. Patients who are from out-of-state, with any insurance other
than Medicare, should contact their insurance carrier before seeking treatment at one our clinics or
before seeking outpatient services at RGH. Any deductibles and/or co-payments are due at the time of
service.

Specialists and other Providers’ Bills:

RGH invites other Physicians and Specialists to provide specialty care services for the continuity of care
and convenience of RGH and Clinics patients. RGH and Clinics’ bills do not include fees for treatment and
services provided by a radiologist, pathologist, anesthesia provider, surgeon or other outside physician
specialist. You will receive a separate bill from these providers.

Additional information will be available on the Hospital website: rio-grande-hospital.org.

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