Financial Services

Financial Assistance

At Kossuth Regional Health Center, we are committed to ensuring that financial challenges do not prevent anyone from receiving the care they need.

Our Financial Assistance Program offers free or discounted care to patients who are uninsured, underinsured, or otherwise unable to pay for medically necessary services.

Who May Qualify

You may be eligible for financial assistance if you:

• Are uninsured or underinsured
• Are not eligible for government programs
• Are unable to pay for care due to financial hardship
• Are a resident of our service area (exceptions may apply for emergency or urgent care)

Eligibility is based on:

• Household income and size
• Available assets
• Other financial resources

Patients with insurance may also qualify for assistance with co-insurance or deductible amounts if they meet financial criteria.

Discount Levels

• 100% discount for households earning less than 200% of the Federal Poverty Level (FPL)
• 73% discount for households earning between 200% and 400% of the FPL

How to Apply

To apply for financial assistance:

1. Complete a Financial Assistance Application (Spanish Application can be accessed here)
2. Provide supporting documents such as:
   
   • Recent tax returns
   • Pay stubs
   • Proof of income or benefits
3. Submit your application to our Financial Counselor department. (Hand deliver or mail)

Kossuth Regional Health Center

Attn: Financial Counselor

1515 S Phillips St. Algona, IA 50511

• Fax: 515-295-4574 Attn: Financial Counselor

Need Help?

Our Financial Counselor is available to guide you through the application process.
Call us at 515-295-4391 or visit us in person, Monday through Friday, 8:00 a.m. to 4:30 p.m.

View our Financial Assistance Policy here.

Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

Para ver sus derechos y protecciones contra facturas médicas sorpresa, haga clic aquí.

You Are Protected From Balance Billing For:

Emergency Services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When Balance Billing Isn’t Allowed, You Also Have the Following Protections:

You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.

Your health plan generally must:

• Cover emergency services without requiring you to get approval for services in advance (prior authorization).
• Cover emergency services by out-of-network providers.
• Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact the Revenue Cycle Manager at (515) 295-4673.

Visit https://www.cms.gov/nosurprises for more information about your rights under federal law.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit

www.cms.gov/nosurprises or call 1-800-985-3059.

Price Transparency

At Kossuth Regional Health Center, we support price transparency. For our patients to understand their potential financial liability for hospital services, our hospital charges are available to patients. Hospital charges vary based on the type of care provided. The price can differ from one patient to the next for the same service, due to the variations that happen in the care needed. The price will be different for complications or different treatment for the patient’s personal health condition. Patients also may qualify for financial assistance.

Please contact the Revenue Cycle Director at 515-295-4673 or send an email to lenzma@mercyhealth.com for a price estimate or to find out if you qualify for financial assistance.

Price Transparency

At Kossuth Regional Health Center, we support price transparency and believe it is important for you to know what out-of-pocket costs you will incur for services provided at our health care facility. We have established two easy ways for you to obtain estimate of your costs – call or click:

Call: By calling, we can give you an accurate estimate of your out-of-pocket costs for a medical service or procedure at Kossuth Regional Health Center. We will review:

• The specific service or procedure you will receive
• The physician providing the service
• Your insurance, including what you have already paid towards your deductible

Call KRHC at 515-295-2451 and speak with Patient Financial Services staff member. They are available Monday through Friday from 8 a.m. to 4:30 p.m.

Click: The information contained in this file is being provided in compliance with the Centers for Medicare and Medicaid Services (CMS) requirement [FY 2019 IPPS/LTCH PPS Final Rule; CMS-1694-F] for hospitals to post a list of their standard charges online in a machine-readable format.

By clicking to download this information you agree you have read and understand the following:

1. The information contained in the file is current as of the last upload. Charge information is subject to periodic changes and the file will be updated as soon as practically possible to reflect such changes
2. The file contains both the charge amount and the charge description of the item or service as reflected in the hospital’s chargemaster (CDM)

• A charge represents the dollar amount assigned to specific medical services before application of any negotiated discounts to third-party payers. The actual hospital charges will vary based on the type of care provided, treatments, individual health conditions and other factors.  If you need an exact estimateof your out-of-pocket cost, please call us at the phone number listed above. PLEASE NOTE THESE CHARGES do not include fees from your surgeon, anesthesiologist or other professional services billed by the physician AND OTHER PROFESSIONAL PROVIDERS. Typically, you will be billed separately for these professional services

1. Following the CMS guidelines, the information in this file represents the hospitals current standard charges as reflected in the CDM. However, it is important to understand that the information represented in the CDM is the starting point in many cases and can undergo additional adjustments through the billing process, therefore, please be aware:
   1. The charge shown is the original charge for the item or service prior to any adjustments that result from applying modifiers in certain situations
   2. The CDM is used in multiple hospital departments and may have different charges for the same item or service and such instances will repeat in the file. For a single chargemaster item, the charge is consistent; however, there may be slight variation in charges for services with similar descriptions for various reasons
   3. Charges for certain items or services are based on per unit, such as – including but not limited to – surgeries, anesthesia, and recovery which can be based on the unit of time and complexity; medications, drugs which can be based on weight-based dosage, age or packaging; etc.
   4. Certain items and or services have a zero dollar price in the CDM for a variety of reasons – contracted billing services that drop charges externally, no cost supplies, Investigational device or medication exemption items in clinical trials and studies, replacement for a recalled or defective device, explode codes and other system limitations. Such items and services will appear with zero dollar and is not reflective of the actual charge. In addition, items and or services are sometimes assigned a one penny price to reflect, for example, a state provided medication or drug, contrast items, therapy status codes used for CMS reporting, etc. and Is not reflective of the actual charge contained outside of the chargemaster
   5. The file may also contain CDM items for non-charges (such as payments, allowances, transactions, etc.)
2. The file is voluminous and download may take excessive time depending on your internet speed.

By clicking to download this information you agree you have read and understand the above.

Rates for KRHC’s self-funded health insurance plan administered by Wellmark for employees and their beneficiaries can be found here.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit

www.cms.gov/nosurprises or call 1-800-985-3059.

Kossuth Regional Health Center is committed to working with consumers, payers and policymakers on developing the best solutions for achieving price transparency goals. Our active participation in CMS rule-making process reflects a strong interest in public policies that support better health, better care and lower costs to ensure affordable, high quality, and people-centered care for all.

Helpful Definitions

Understanding health care words related to price can pose significant challenges for patients. If you ask a group of people to define what “price” is, it is likely you will get a variety of answers. Below are definitions to help patients understand the terms used in the price estimate information:

Charge

The dollar amount assigned to specific medical services before negotiating any discounts from payers. The charge is different from the price. Very few patients pay the charge regardless of their insurance status; and, therefore, this data is not meaningful to people.

Price

The negotiated and contracted amount to be paid to providers by payers (also called the “allowed amount”). A patient’s out-of-pocket liability for health care services is based on this allowed amount. Note that the price for a given service varies by insurance plan as these are separately negotiated by plan/employer.

Out-Of-Pocket

Portion of the price for medical services and treatment for which the patient is responsible. This includes copayments, coinsurance, and deductibles.

Cost

The definition depends on the cost being referenced: To the provider, cost is the expense incurred to provide health care to patients. To the employer, cost is the expense related to providing health benefits. To the insurance plan, cost is the price paid to the provider. To the patient, cost is the out-of-pocket fees.