Billing FAQ

Find the answers to our most common questions.

  • Billing

    • How can I get a copy of my bill?
      • Contact us to request a copy of your bill. Call 319-332-0999 or e-mail Please have the account number from your statement available, if possible.
      • Our Patient Financial Service representatives are available to help you with any questions you have about your bill.
    • What if I cannot pay my bill in full?
      • We will perform services that are indicated to be medically necessary, regardless of your ability to pay.
      • A Financial Assistance Program is available to eligible individuals who have healthcare needs and are uninsured, underinsured or otherwise unable to pay for medically necessary care. Please contact Patient Financial Services at 319-332-0999 or for more information.
      • We will accept reasonable regular monthly payments. Contact a patient financial services representative at 319-332-0999 to set up a monthly payment plan.
    • Which credit and debit cards are accepted?
      • Credit or debit cards: MasterCard, VISA, Discover or American Express
    • What is the best method to pay my bill?
      • Via mail. Our address is 1600 First Street East, Independence, IA 50644-3155.
      • On our website – Click link at the top of the page.
      • By calling us with your debit or credit card number. Call 319-332-0999 and ask for Patient Financial Services.
      • In person.
  • Insurance

    • What do I do if I disagree with how much my insurance company has paid on my bill?
      Contact the insurance company and ask how your claim was processed. If the insurance company finds an error was made, write down the information you are given as well as the name of the person you spoke with at the insurance company. Request an anticipated payment date. If the bill does not get paid in the time frame they gave you, follow-up with the insurance company again. If the insurance company feels the bill was paid correctly and you still disagree, ask them how to file an appeal. Filing an appeal will not guarantee more payment, but the claim will be reviewed for reconsideration.
    • How will I know if my insurance company has paid my bill?
      Your insurance company will mail an Explanation of Benefits (EOB) to you. This will explain what was paid or not paid by them and why. If there is a balance due, to be paid by you, after the insurance company has paid its portion, we will send you a bill that will indicate the amount that has been paid and any balance needed.
    • How do I follow-up with my insurance company?
      Call the insurance company by referencing the phone number on the back of your insurance card. Have ready your insurance card, date of service, facility name, billed amount, patient name, and claim number. Ask for the status of the account. If it has been paid, ask when and to whom. If it has not been paid, find out when they expect to pay and if they need anything from you. Write down the information you are given as well as the name of the person you spoke with at the insurance company. If the bill does not get paid in the time frame they gave you, follow-up with the insurance company again.
    • How do I know if my insurance company will cover services provided by all professionals (i.e. CRNAs, radiologists, and pathologists)?
      Each professional or specialist needs to contract individually with insurance companies. Check with your insurance company or employer about coverage prior to receiving services.
    • How do I know if my insurance company will cover my visit or certain services?
      Refer to your insurance handbook or call your insurance company with questions about a service or visit prior to your appointment. That phone number can be found on the back of your insurance card.
    • Do I need to let my insurance company know that I’m going to be in the hospital?
      Your insurance company or employer can help you to determine notification requirements and what is or is not covered by your insurance plan. Because there are many different insurance plans, our staff does not know whether a specific service will be covered.
    • Will you file worker’s compensation, motor vehicle accident or medical liability claims for me?
      Yes. We will bill any of these claims as long as you provide us with the correct information. We ask our patients to file a “First Report of Injury” with your employer, as needed.
    • Why should I bring my insurance card and picture ID with me to my appointment?
      A copy of your insurance card, picture ID and the forms you will sign at registration are needed to file a claim to your insurance company. Without correct and complete information, your insurance company cannot pay for your visit.
    • What does in-network mean to me?
      To get full insurance benefits, patients are sometimes required to receive services from an “in-network” or “participating provider”, designated by their insurance companies. Please contact your insurance company and ask them if Buchanan County Health Center is in their network. If they do not find us in their “in-network” system, please contact us at 319-332-0999.
  • Medicare

    • What are Advance Beneficiary Notices?
      Medicare covers medically necessary services and certain preventive services. Please visit for specific benefit coverage information. If you have Medicare and your doctor, health care provider, or supplier thinks Medicare probably (or certainly) won’t pay for items or services, they may give you a written notice called an “Advance Beneficiary Notice of Noncoverage” (ABN). The ABN lists the items or services that Medicare isn’t expected to pay for, an estimate of the costs for the items and services, and the reasons why Medicare may not pay. The ABN gives you information to make an informed choice about whether or not to get items or services, understanding that you may have to accept responsibility for payment. Because Medicare is unlikely to pay for the service does not mean that you should not receive it. There may be a good reason your provider ordered the service. Publications for Medicare Beneficiaries PDF
    • Why am I getting a bill for medications during an outpatient stay or service?
      Medicare Part B does not cover drugs considered to be self-administrable. This means that you, in another setting, could have taken the medication by yourself. Medications considered to be self-administrable include: tablets, inhalers, sprays, ointments, drops, and some injectibles, such as insulin. Most Medicare supplements also do not cover the self-administrable medications. Please see your Medicare handbook, visit the Medicare website ( or call Medicare (800-522-8323) if you have additional questions.
    • Will my service or visit be covered by Medicare?
      Medicare covers medically necessary services and some preventive services. The preventive services coverage is often dependent on the frequency of the service. For specific benefit information, please refer to
    • Will I have to pay any money for my hospital visits?
      Yes. As a Medicare patient, you will be responsible for non-covered charges, co-pays and deductible amounts. These amounts may vary depending on your Medicare coverage. We do not know what your payment may be until we receive the notification from Medicare. Once Medicare lets us know your responsibility, either you or your secondary insurance company will be responsible for the balance.
    • Should I pay the balance that is listed on “your total responsibility” on the Explanation of Benefits form?
      Because this amount could change, please wait until you receive a bill from us before making payment.
    • What is the difference between Part A and Part B Explanation of Benefits forms?
      Part A covers inpatient hospitalization and Part B covers outpatient and provider services.
    • What should I do with the Explanation of Benefits form?
      We recommend you keep the Explanation of Benefits forms you receive from Medicare until your medical claims have been paid in full.
    • What is a Medicare Explanation of Benefits form?
      The Explanation of Benefits (EOB) form is a document that Medicare and other insurers send to patients after the insurer has processed your medical claims. The EOB form provides you with information about the payment status of your bill.
    • Do I have to sign any forms before BCHC can bill Medicare?
      Yes. Medicare requires that we ask questions to determine the insurance with primary responsibility for the claim at each visit. You will also need to sign the Consent for Treatment form each time you receive services.
    • I have health insurance in addition to Medicare coverage. Will you bill that insurance company also?
      Yes. If you have given us information about your additional health insurance, we will bill that insurance company.
    • If I have Medicare coverage, why do I have to give you information about other insurance?
      Medicare requires us to bill any insurance company that may be responsible before we bill Medicare. We cannot file claims until your other insurance company has determined what they are responsible for paying. If you enrolled in a Medicare Advantage Plan, that plan is responsible for your medical claims. Medicare Advantage Plans are not the same as Medigap Plans or Medicare Supplements. Some Medicare Advantage Plans have provider networks and may require you obtain a referral for services. For more information on Medicare Advantage plans, refer to Medicare’s “Medicare and You” handbook. For information on how your Medicare Advantage Plan works, contact your insurance plan or refer to the Evidence of Coverage supplied by your plan.
  • Price Transparency

    • What is price transparency?
      The healthcare industry has previously been reluctant to share prices (charges). This reluctance was a result of huge variation in insurance plans as well as lack of understanding of what charges truly mean. The Affordable Care Act (ACA) added guidelines to encourage hospitals to engage in consumer friendly communications of their charges to help patients understand what their potential financial liability might be for services and to enable patients to compare prices across hospitals. BCHC wants to be upfront with our charges for services. Our hospital submits financial information to the Iowa Hospital Association who then provides patients with not only BCHC charges, but also charges of other hospitals throughout the state of Iowa. This information can be found at The goal of price transparency is to allow the consumer to make a choice not only based on clinical criteria but also financial criteria. While this website is a good first step, the consumer must also understand what charges mean. To help a patient understand their financial liability, we need to understand the difference between charges, insurance payments, and patient out of pocket responsibility.
      • Price/Charge is defined as the dollar amount set by the hospital for a particular service or supply needed for the medical treatment.
      • Insurance payment is what the hospital actually receives from Wellmark, Medicare etc. Each insurance company negotiates with healthcare providers and never pay full charges. These discounts are known as network savings.
      • Patient out of pocket responsibility – The amount predetermined by a patient’s insurance plan that the patient will owe to the hospital after receiving the insurance company’s contractual discount and payment. Some of the key terms to understand related to patient out of pocket responsibility are:
        • Deductible – The amount you pay for services before health insurance begins.
        • Co-insurance – The patient’s share of the costs of health care services after you have paid your plan’s deductible
        • Out-of-pocket maximum – The maximum total amount a patient will pay for deductibles, co-insurance, and co-payments for the fiscal year.
      The most important takeaway here is that while charges may seem high, they do not reflect actual reimbursements that hospitals receive. The following is an example of the transactional process through the healthcare industry. Example: A typical patient having cataract surgery with insurance may get charged $5,300 for the procedure. When the charge is submitted through insurance, the hospital receives the discounted amount after Network Savings are applied. In our example, we’ll assume the Network Savings are 40%, but understand that these rates can vary widely. Depending on the patient’s insurance, they may be required to pay all of the balance less network savings if their deductible has not been met or if their deductible has been met, they may pay a co-insurance. For our example, we will assume the following background information:
      • Patient has a $1,500 deductible, a 20% co-insurance, and a $5,000 out-of-pocket maximum.
      • Patient has paid $1,000 of the $1,500 deductible due to previous services the patient received leaving a $500 balance.
      • Patient has paid $1,250 of their $5,000 out of pocket maximum.
      The $5,300 charge claim would be handled the following way:
      • Hospital would write off $2,120 of the charge (the Network Savings) leaving expected payment of $3,180.
      • Patient pays the first $500 of the bill due to the remaining $500 deductible
      • After the deductible is met, the patient would pay their co-insurance of 20% for the services rendered less the deductibles per the following formula:
        • $3,180 due payment minus $500 (deductible) = $2,680 left to be paid. 20% Co-Insurance of $2,680 = $536. Total between the deductible and co-insurance the patient responsibility for this service is $1,036.
        • The remaining balance of $2,144 ($3,180 minus $1,036) is paid by the patient’s insurance company.
        • Patient’s current balance of their out-of-pocket maximum is now $2,286 of $5,000.
      As you can see from the example above, the process is complex. To make it even more complex, every patient has different insurance plans with different deductibles, co-insurance, out-of-pocket maximums, and co-pays. To understand the true picture of your individual plan and patient responsibility, please call our patient financial services department (319-332-0999) and request a patient responsibility estimate free of charge. Our patient financial services department will review your insurance information, estimate the charges for services and then provide an estimate of what your responsibility will be. At that time, they can look at payment options along with reviewing other services our hospital offers. Our goals is to not only provide the highest level of care for you, but to put your mind at ease with understanding the financial impact this may have on you.