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Billing & Insurance

Billing & Insurance 2018-05-14T09:03:14+00:00

Billing & Insurance

At CentraState, our goal is for you to focus on getting healthy, not on insurance claims or payment hassles. For information regarding your bill and post-billing time payment arrangements, please call 732-294-7065.

FAQs

Step 1 – If a patient has insurance and proper information is submitted by the patient or patient’s representative during a hospital stay, CentraState will bill the patient’s charges to the insurance company as soon as possible after discharge.

Patients scheduled for elective admissions, or for elective outpatient procedures, must make arrangements prior to their admission for the payment of any amounts that will not be covered by the patient’s insurance.

Any patient having inadequate insurance coverage, or no insurance coverage, will be asked to make appropriate deposits at the time of admission. If you need information about deposit requirements and pre-payment options, call 732-294-2632.

Any balance in a patient’s account that exceeds the estimated insurance benefits are due from the patient or patient’s guarantor at the time of discharge.

Step 2 – Shortly after receiving care at CentraState, you will receive a statement describing the charges for services you received. The statement will include information on where to send payment along with posting of information from your insurance company if you have insurance.

CentraState will work closely with patients and their insurance companies regarding payment, however patients have the final responsibility of settling their accounts.

Charges fall into two categories:

  • A basic daily rate, which includes your room, meals, nursing care, housekeeping, and telephone
  • Charges for special services, including items your physician orders for you, such as X-rays or laboratory tests

If you had certain tests or treatments in the hospital, you may receive separate bills from physicians you did not see in person. Such bills are for the professional services provided by these physicians—for example, reading and interpreting test results or providing surgical services—while you were hospitalized.

These physicians who were integral in delivering your care are independent professionals (i.e., “independent contractors”) who are not employed by CentraState, but who have certain privileges to perform medical services at CentraState Medical Center. They may include pathologists, radiologists, anesthesiologists, cardiologists, and other specialists. Their independent services are not reflected in your basic hospital bill, and they are required to submit separate bills.

If you have questions regarding a physician bill, please contact your physician’s billing office or, for select physician groups, the numbers listed below:

Emergency Physicians (Central Jersey Emergency Medical Associates): 866-898-7142

Anesthesiologists (Liberty Anesthesia): 800-431-5379

Radiologists (Princeton Radiology Associates): 732-462-3302

Pathologists (Hackensack Pathology Associates, LLC): 800-213-5135

Neurologists (CJNA – EEG readings only): 732-866-6484

Neonatologist (Central Jersey Newborn Care): 908-829-3465

We will need a copy of your insurance card. All patients will be asked to pay a deposit, depending on the extent of your coverage and deductible requirements. We may also need the insurance forms supplied by your employer or the insurance company. You will be asked to assign benefits from the insurance company directly to the hospital.
CentraState accepts a wide variety of health insurance plans. Most of those plans are listed on the chart below. Because insurers generally offer a variety of plans with different levels of coverage, you should always check with your insurance carrier to verify what services are covered, the extent (percentage) of coverage provided, and what, if any, deductibles, co-pays, and/or other expenses you may be responsible for under your particular insurance plan.

If your carrier is not listed, you may still be covered. For the latest information about your coverage, please check with your insurance carrier. You can also contact our Managed Care office directly by calling 732-294-7055.

Resources: NJHA Guide to Using Health Insurance

Please NOTE:

Physicians who participate in your care, including emergency room physicians, surgeons, radiologists, anesthesiologists, pathologists, and consultants, are private practitioners and not employees or agents of CentraState Medical Center. CentraState cannot assure that all physicians or consultants participate with all insurance plans. Your physicians’ bills will be separate from the medical center bill. Please contact your insurance company to find out if these physicians are covered by your insurance plan.

CentraState Medical Center is a participating provider in all Horizon Blue Cross Blue Shield health plans. Due to continuing changes in benefit plan designs, be sure to check your specific plan details for any restrictions/changes in coverage. In addition, CentraState Medical Center and Immediate Care Medical Walk-in are fully participating members of Aetna Insurance.

*Please scroll horizontal to view full table details

INSURANCE CARRIER HMO/PPO/POS MEDICARE MEDICAID MENTAL HEALTH THE MANOR
Active Care (Workers’ Comp) X
Aetna Health Plans of NJ X X X X
America’s Health Plan X
Amerigroup X X X
AmeriHealth X X
BeechStreet PPO X
Cigna X X
Clover Health X
Community Care Network X
Consumer Health Network (CHN) X
Devon Health Services X
Empire BlueCross/BlueShield X
Emblem Health PPO
First MCO (Workers’ Comp) X
Geisinger Health Plan X X
Great-West (Cigna) X
GHI PPO
HealthNet Federal Health Services (TriCare-Champus) X
Health Republic Insurance of NJ X X
HIP PPO
Horizon BlueCross/BlueShield of NJ X X X X
Horizon Medicare Blue Products*:

Horizon Medicare Advantage NJ Direct 10-15 (PPO),

Horizon Medicare Blue Value (HMO),

Horizon Medicare Blue Choice (HMO),

Horizon Medicare Blue Access Group (HMO/POS),

Horizon Medicare Blue (PPO),

Horizon Medicare Group (PPO)

*We do not accept Horizon Medicare Blue Advantage (HMO)

X
Horizon Casualty Services (Workers Comp & No Fault) X X
Intergroup Services Corp X
MagnaCare X
MCS Patient Centered Health Care Network X
Multiplan X
National Provider Network X
Optum Behavioral Health X
Oxford Health Plans X X X
Private Healthcare Systems X
QualCare X X
QualCare Workers Comp X X
United Healthcare X X X
Wellcare X X

* NOTE: Please be aware that this list is subject to change

We will need a copy of your Medicare card to verify eligibility and to process your Medicare claim. You should know that the Medicare program specifically excludes payment for certain items and services, such as cosmetic surgery, some oral surgery procedures, personal comfort items, hearing evaluations, and others. Medicare only covers ambulance services when transportation by any other means would endanger the patient’s health. Deductibles and co-payments are also the responsibility of the patient.
We will need a copy of your Medicaid card for verification. Medicaid also has payment limitations on a number of services and items. Medicaid only pays for the cost of a semi-private room.
Your plan may have special requirements, such as a second surgical opinion or pre-certification for certain tests or procedures. It is your responsibility to make sure the requirements of your plan have been met. If your plan’s requirements are not followed, you will be financially responsible for all or part of the services rendered in the hospital. Some physician specialists may not participate in your health care plan and their services may not be covered. Deductibles and co-payments are due on or before discharge.

In accordance with the New Jersey Hospital Care Payment Assistance Program, NJAC 8:31B (commonly known and hereinafter referred to as “Charity Care”), patients who would like information about enrolling in and becoming eligible for any public assistance medical plans and/or qualifying for Charity Care for medically necessary services may call 732-294-2641. The CentraState team will assist you in reviewing payment options, including time payment arrangements and eligibility for financial assistance.

View the NJ Hospital Care Assistance Program (Charity Care) Application

The NJ Hospital Price Compare website provides CentraState’s inpatient charges as compared to other hospitals, along with general hospital charging information. The price comparison data is only updated periodically and is for comparison purposes only; it does not provide pricing estimates.

Please keep in mind that charges can be considered a ‘sticker price’, and are discounted for virtually all health care customers. The amount billed to you depends on whether or not you have insurance and, if you have insurance, the terms of the insurance policy. It also depends on whether you are eligible for, have applied for, and been approved for the NJ Hospital Care Assistance Program.

If you are eligible for financial assistance, you may complete the NJ Hospital Care Assistance Program form provided here. Our Financial Assistance Policies are provided as well for your convenience. If you have any questions prior to mailing or bringing your application in, please feel free to contact our department at 732-294-2641.

Helpful documents:

Health Plan FAQs

A few of the first questions you may wish to ask your human resources department or insurance carrier about your health plan options are whether there have been any changes to your benefit plan and whether there are any disincentives for continuing to see your same doctors. Some health plans now offer tiered products. This means that some participating doctors and/or the hospitals they are affiliated with will cost you more in terms of co-pays and deductibles than other doctors/hospitals within the plan.

CentraState participates in most health insurance plans.  Before selecting a new health plan, please make sure that you understand any limits that may be in place to continue to receive care from CentraState. Just as seeking care from some doctors may cost you more out of pocket, some hospitals may cost more as well. When you change or renew a health plan, we want to make sure that you are able to continue to receive your care from us and your CentraState-affiliated doctors without paying more in out of pocket expenses.

Before you make any plan changes, make sure that your doctors and CentraState Medical Center are part of that plan and that you understand what out-of-pocket expenses there may be in order to receive health care services from your doctor and at CentraState. It’s a good idea to review all of your health benefit options to see which plan best meets your individual needs.

Many factors are important in choosing a health care partner, including cost, quality, and patient satisfaction. For more than four decades, CentraState Medical Center has offered award-winning health care services and a compassionate team of physicians, nurses, and clinicians dedicated to providing quality care. CentraState consistently maintains favorable rankings in state and federal industry measures, including the following.

  • CentraState Medical Center’s average revenue per adjusted admission (based upon acuity or severity of illness) is one of the lowest in the state.  In addition, CentraState has been recognized by Verras Healthcare International as one of the 10 Best Value Hospitals in New Jersey.
  • CentraState consistently achieves patient satisfaction scores in the 90th percentile according to Press Ganey, a nationally recognized, independent research organization. We rank among the best hospitals in New Jersey in terms of patient satisfaction.
  • CentraState Medical Center is one of only 2 percent of hospitals nationwide to achieve Magnet® designation for nursing excellence three times as part of the American Nurses Credentialing Center’s Magnet Recognition Program.® Only 8 percent of the approximate 5,800 hospitals in the U.S. hold Magnet designation, so a three-time designation is an elite accomplishment.

Be sure to thoroughly review your health plan options before making a selection. Check to see that all of your doctors and CentraState are included in the list of the selected plan’s participating providers. In addition, be certain that you won’t have to pay more to maintain a relationship with your CentraState-affiliated doctors and CentraState Medical Center.

We believe in freedom of choice – choice in doctors and health care providers –to best treat your health care needs. If you have any questions about health plan selection, please reach out to your human resources department or contact your insurance carrier directly.

No. CentraState’s agreement with PHCS does not include Humana, Inc. and the Mail Handlers Benefit Plan. It is essential for patients to confirm their specific health insurance coverage before seeking services at CentraState or any other health care provider.

Horizon OMNIA FAQs

Yes. Horizon is now requiring physicians to use your appointment time to explain their plans. Although physicians should discuss insurance questions with their patients, we don’t think doctors should be forced to promote Horizon plans. Rather, they should maximize their limited time to assess your health and discuss any concerns either of you may have about your health. We believe doctors are meant to practice medicine, not sell health insurance.
Yes. If you have the Horizon OMNIA plan, you may continue to see the same physicians who have always treated you and the hospitals that you are most comfortable with. However, hospitals that are deemed to be tier 2 will cost you more than tier 1 hospitals in co-pays and deductibles. We believe essentially this means that Horizon is making you choose between lower out-of-pocket expenses and your own doctors who know you and have treated you. We believe patients—not their health insurer—should be the ones to choose who works with them to gain and maintain their optimal health.
No. CentraState does not oppose tiered plans that use and apply objective, fair, and transparent criteria set out in advance. CentraState understands the need for tiered plans in the current health care landscape. However, we oppose the nontransparent way in which Horizon selected physicians and hospitals to be part of their tier 1 and tier 2. When establishing criteria for a tiered health plan is done in an open way with clearly identified standards, we fully support this means to control health care costs.
Yes. Anyone insured through any Horizon plan will be able to use CentraState Medical Center as an in-network provider. If you have selected the OMNIA plan, you are still able to receive care from CentraState, but you will pay a higher deductible and co-pay.
Yes. When you download a customized physician and hospital directory from the Horizon home page, regardless of the plan you select, physicians and hospitals will be designated as either tier 1 or tier 2 – even though the designations only apply to OMNIA plans.
Yes. Call the Department of Banking and Insurance (DOBI) at 1-800-446-7467 to express your concerns and learn what program is best suited for your individual or family needs.

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