Billing, Insurance & Payment

Valley Presbyterian Hospital is committed to providing financial assistance to patients who cannot pay for part or all of the care they receive. Consistent with our mission and values, we embrace the following principles:
  • Patients should be treated equally, with dignity, respect and compassion.
  • Concern over a hospital bill should never prevent any individual from receiving emergency health services.
  • Patients should be expected to contribute to the cost of their care based upon their individual ability to pay.
  • Hospital financial aid policies and practices will take into account each individual's ability to contribute to the cost of his or her care, as well as the hospital's ability to provide care.
  • Financial aid policies should be clear, easy-to-understand, and communicated in a way that is dignified and in languages appropriate to the community and patients served.
  • Financial aid policies should be made available to prospective and current patients and to the community at large.

Rosenthal Act

Rosenthal Fair Collection Practices Act and Federal Fair Debt Collection Practices Act:

State and federal law require debt collectors to treat you fairly and prohibit debt collectors from making false statements or threats of violence, using obscene or profane language, and making improper communications with third parties, including your employer. Except under unusual circumstances, debt collectors may not contact you before 8:00 a.m. or after 9:00 p.m. In general, a debt collector may not give information about your debt to another person other than your attorney or spouse. A debt collector may contact another person to confirm your location or to enforce a judgment. For more information about debt collection activities, you may contact the Federal Trade Commission by telephone at 877-FTC-HELP (877-382-4357) or online at www.ftc.gov.

Patient Financial Services Collection Process Guidelines

Purpose:

To provide guidelines to ensure accounts are followed-up in a timely manner.

Guidelines:

In order to ensure that proper and timely follow-up on accounts is performed after billing, the procedure below must be followed. Some exceptions can be made, as risk management may need to hold, adjust or write off an account. Other exceptions may be granted by the Chief Financial Officer or the Director of Revenue Cycle. All new staff members are trained on the process below.

Procedure:

A. Managed Care, Commercial, Medicare, Medi-Cal and all payers:

  1. After claims are submitted to the insurance carriers either electronically or hard copy, the Patient Financial Services (PFS) staff calls or inquires on the website of the insurance company to see when the claim will be paid. If there is a secondary or tertiary payer, the claim is then submitted to that carrier. Once the insurance company has issued payment, and the account has been reviewed by the claims adjuster, the balance remaining is due by the patient.
  2. If a denial is received, the account is resubmitted or appealed based on the type of denial. If the claim continues to be denied by the insurance carrier for reasons such as no medical necessity or no authorization, the claim may need to be written off.
  3. Ten days after the payment is received, and there is a patient balance owing, the account is reffered to Healthcare Resource Group (HRMG) which is used as an extension of the Business Office. HRMG sends out a series of letters to patients, requesting payment on his/her account. The account remains with HRMG for 120 days while they pursue the patient. If no payment or payment arrangement is made in that time, the account is then referered to an outside Collection Agency.

B. Self-Pay accounts:

  1. Self-pay accounts are referred to HRMG three days after the claims become Final Bill status. HRMG sends out a series of letters to patients, requesting payment on his/her account. The account remains with HRMG for 120 days while they pursue the patient. If no payment or payment arrangement is made in that time, the account is then referred to an outside Collection Agency. If insurance is found after an account has been referred to an outside Collection Agency, the agency either bills and follows up on the account, or returns it to the hospital for billing and follow up, depending on the insurance.

C. The outside Collection Agency assigments are determined by an alpha split that changes yearly. The Collection Agency abides by all hospital policies.

Please contact our Patient Financial Services Department at 818.902.2913 for more details.