Insurance & Payment
If you have health insurance, please ensure that our Patient Account Services Department has received your identification numbers. If your insurance requires pre-certification or authorization, please make sure you have met those requirements. If you have questions or need assistance, please contact our Prior Authorization Department at 218-347-1353. The facility will submit and process insurance claims. Your insurance is a contract between you and your insurance, and you have final responsibility for payment of the facility bill. Credit balance accounts are to be resolved within 30 days of the account entering a credit status. The facility will make a refund to the appropriate party.
Perham Health’s Financial Assistance Program was established to assist patients whose annual incomes are at or below 200 percent of the Federal Poverty Level. You may be eligible for discounted rates if you fall between 200 and 300 percent.
Perham Health is committed to provide emergency and medically necessary care to all patients. Patients receiving services and who meet eligibility criteria, can apply for financial assistance.
Beginning January 1, 2019, the U.S. Department of Health & Human Services and Centers for Medicare & Medicaid Services are requiring hospitals and health systems to post “current, standard charges.”
Hospital charges are the amount a hospital bills an insurer for a service. For most patients, hospitals are reimbursed at a level well below charges. Patients covered by commercial insurance products have negotiated rates with hospitals. Patients covered by Medicare or Medicaid programs have hospital reimbursement rates determined by federal and state governments. Patients without insurance may also be eligible for discounts under the MN Attorney General Discount Program.
The prices depicted on Perham Health’s price transparency web page are from the current chargemaster and reflect prices that were in effect as of the new fiscal year, beginning October 1, 2019. There could be instances where charges in an individual department or an isolated charge may change during the fiscal year and may have been updated since this document was created.
Hospital charges may include bundled procedures, personnel, services and supplies. An example would be room rates that include the space, equipment, nursing personnel and supplies.
The data presented will show individual charges and may be difficult for an individual to use for help in calculating the total charges he or she may incur during a visit and the applicable out-of-pocket expenses he or she may be responsible for. We encourage our patients to contact Patient Financial Services at (218) 347-1350 for help with specific circumstances.
When a patient has the opportunity to shop for medical services, he or she should contact his or her own insurance carrier to understand which costs will be covered and which will be the patient’s responsibility.
In addition to resources on this website, there are additional resources available that provide summarized charge data at either a diagnosis-related group (DRG) level or outpatient procedure level. The Minnesota Hospital Association website can provide an estimated cost for procedures performed at Perham Health as well as cost compare to other facilities.
The Minnesota Legislature passed a law that requires certain clinics to report amounts for their 25 most frequent services that cost more than $25. The services listed here do not reflect all of the services provided at this clinic.
Charges represent the standard amount a clinic bills for a service. For most patients, clinics get paid an amount well below the listed charge.
The amounts posted in the document linked above DO NOT reflect the amount(s) each clinic patient will pay for the services listed. For specific information about the amount you will owe for the services you receive, please contact your insurer.
- Patients covered by commercial health insurance or a Medicare Advantage plan: Your health insurance company has likely negotiated a discount or contracted rate for each service. Your health insurance company’s negotiated price might be higher or lower than the average commercial payment amount listed above. To learn more about your health insurance company’s negotiated price or how much you will owe under the terms of your specific health policy, please contact your health insurance company.
- Patients with government-sponsored health coverage, such as Medicare or Medical Assistance: The payment rates listed above reflect amounts set by Medicare or Medical Assistance, not by this clinic. These listed rates do not reflect the amount you might owe as a co-payment.
- Provider-Based Billing: Perham Clinic is considered provider-based by Medicare. Provider-based is a term used to identify facilities that are fully integrated with a main provider. In our case, Perham Health (hospital) is the main provider and through this distinction is allowed payments to the hospital to cover the costs of operating the clinic. This means patients may receive two charges on their statement for services provided in the clinic – one charge represents the facility or hospital charge and the other charge represents the professional or physician fee. These charges may result in a co-insurance liability for which you will be responsible. However, your actual liability will depend upon the services provided.
Depending on each patient’s specific insurance coverage, it is possible some patients may pay more or less for services compared to other facilities. Provider-based billing is typically only recognized by Medicare and Medicaid programs, and is not a factor for commercial insurance coverage. Please note, Perham Health’s clinics in New York Mills and Ottertail are not considered provider-based and do not fall under these rules.