As a courtesy to our patients, when you receive services at Sanford Health, we bill your insurance carrier directly. To be sure the claim is properly submitted, we need a copy of your insurance card. HIPAA regulations require that we supply insurance carrier's complete information on the person that carries the coverage. This includes the name, address, phone number, date of birth and social security number. Incomplete information could mean a denial from your insurance carrier. When your insurance carrier delays, denies or makes partial payment, you are responsible for the balance.
Any additional patient financial responsibility is due by the due date on your patient billing statement. You may receive more than one statement for services rendered at Sanford Health.
If you receive a patient billing statement and do not understand the content, or if you believe that the information may be incorrect, please contact Patient Financial Services at (877) 629-2999. Our office hours are 7 a.m.-6 p.m. Monday-Thursday and 7 a.m.-5 p.m. on Friday.
Out-of-network refers to a patient seeking care outside the network of doctors, hospitals or other health care providers that the insurance company has contracted with to provide care. It usually applies to health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
Any payment made by your insurance carrier will be reflected on your patient billing statement. In addition, your insurance carrier will send, directly to you, an explanation of benefits (EOB) that details how your medical claim was processed and paid according to the benefit structure of your health insurance plan. This EOB will also indicate the patient due amount resulting from the payment of the listed services.
If your claim is denied, you should contact your insurance carrier directly for an explanation about how your claim was processed.
To ensure prompt payment of your claim, please provide Sanford with your most up-to-date insurance card. Always take your insurance card with you to your appointments and make sure your health care providers have your current insurance information. If your insurance information has changed, you may provide that updated information to a representative by calling Patient Financial Services at (877) 629-2999. You may also send a copy of the updated insurance card to Sanford Health, P.O. Box 5074, Sioux Falls, SD 57117 or fax to our secure fax number at (605) 328-8311.
Medicare is a "last payer insurance." Federal law mandates that all Medicare providers complete the Medicare Secondary Payer (MSP) Questionnaire to verify at each visit that you or your spouse does not have an Employer Group Health Plan that would be primary over Medicare. When audited, we have to show proof that for each time you received services, you were asked specific questions relating to the possibility of other insurance. Additionally, if you are in an accident and someone else is at fault, the other party is responsible for your medical expenses according to federal law.