Frequently Asked Questions
Co-Pays, Deductibles and Patient Balances
Patients with commercial or managed care coverage are responsible for paying co-pays, deductibles and fees for non-covered services at the time of medical service. Please review your insurance policy benefits. If you have questions about your coverage, contact your employer or insurance company.
Payment Options and Discounts
Accepted payments are listed below, as well as information about financial assistance. The patient or guarantor is responsible for payment of non-covered services. Deductible, coinsurance and patient estimated portions are due at the time of service.
Personal check or check card
90 days same as cash
Credit cards: Visa, Mastercard, Discover
Payment arrangements – contact Customer Service (*need to add phone number*)
Financial assistance for patient who meet Federal Poverty Guidelines through the Care Assistance Program (CAP)
WestCare recognizes that healthcare is expensive and often unexpected. High quality medical care is provided to all patients regardless of their ability to pay. Financial Counselors are on staff to assist with potential eligibility for North Carolina Medicaid, other state and federally funded healthcare programs and the Financial Assistance Program.
For potential Medicaid eligibility please contact:
Harris Regional Hospital / WestCare Medical Park of Franklin 828-586-7411
Swain County Hospital 828-488-4020
A 75% write-off is provided on household income 151% -300% of the Federal Poverty Guidelines.
Patients eligible for discount are responsible for the following co-payments at time of service:
A. Inpatient – $10.00
B. Outpatient – $10.00
C. Urgent Care – $10.00
D. Emergency Department – $20.00
E. Rehabilitation services – $5.00
F. All other services – $10.00
Upon approval, associated patient invoices remaining in active receivable status will be adjusted based on eligibility level. Future visits and services shall be eligible for adjustments for 12 months from the decision date. Retrospective visits shall be approved only for services remaining in active receivable status.
Referral for Financial Assistance may be made by any member of WestCare staff, medical staff, nurses, financial counselors, social workers, case managers, chaplains, family members, patients, guarantors and any other person.
For patients that do not qualify for financial assistance our financial counselor is available to help determine potential opportunities for partial assistance with catastrophic medical bills.
The following healthcare services are eligible for Financial Assistance:
1. Emergency medical services
2. Services for which if not treated promptly would lead to an adverse change in health status
3. Non-elective services provided in response to life-threatening circumstances in a non-emergent setting
4. Medically necessary services evaluated on a case by case basis
5. Services at WestCare hospitals and physician practices owned and operated by WestCare.
This policy is not applicable to physicians, immediate family members of physicians (as defined in 42 C.F.R. 417.351, as amended) or to any patient who is a referral source to a WestCare entity. WestCare reserves the right to grant financial assistance to patients in extraordinary circumstances who do not satisfy the guidelines stated above.
Please print and mail your application to:
Karen Williams, Financial Advocate, c/o Outpatient Registration68 Hospital Rd. Sylva, NC 28779 (828) 586-7355
Please include all requested information and documentation to avoid delay in processing.
Financial need will be determined in accordance with procedures that involve an individual assessment. The assessment may involve full supporting documentation of eligibility.
Patients shall be notified in writing of financial assistance approval or denial within 30 days of receipt of all required information. Determination letters shall be mailed to inpatients. Notification for outpatient and physician services will be provided on the billing statement or upon request.
Patients and responsible persons may receive charge estimates for services. Please remember this is an estimate only. Final charges are based on physician orders and total services performed.
Harris, Swain, and Franklin:Â 828-586-7189 or 828-586-7398
Many insurance companies require precertification or prior authorization before a scheduled hospital stay or before outpatient procedures and testing. Registration and Care Coordination staffs makes attempts on your behalf to provide information requested by your insurance company including working with the Physician to obtain necessary precertification. Although we assist in gathering this information, we cannot guarantee approval from your insurance carrier. Ultimately the patient or policyholder is responsible for notifying the insurance company in advance.
Please present a current insurance card when registering and checking in for services.
The information on the card is important identification of insurance benefits and patient privacy. It is important that we receive your insurance information quickly. Your insurance company may have a timely filing deadline that must be met in order for your benefits to be paid. Balance penalties could result in patients paying higher out of pocket amounts without accurate and timely information. There may be some services that insurance will not cover. The patient or guarantor is responsible for payment of non covered services. Deductible, coinsurance and patient estimated portions are due at the time of service.
When you schedule a service at any of the WestCare sites you may be contacted by one of our Pre-registration staff to obtain your demographic and insurance information prior to your visit. Providing this information in advance will save you time the day of your service. The Pre-registrar will take time to explain your insurance coverage and any deductibles or coinsurance that may be due from you.
WestCare will submit Medicare claims for patients. Patients are responsible for deductibles, coinsurance and amounts for non-covered services.
Medicare Part A covers inpatient hospitalization services
Medicare Part B covers outpatient hospital services, medical and physician services
Medicare Part C – otherwise known as Medicare replacement or Medicare Advantage Plans covers various healthcare services based on your benefits and is considered Medicare Managed Care
Medicare Part D covers retail pharmacy items.
WestCare Patient Financial Services Departments submits insurance claims for Medicare supplemental policies when complete information has been provided.
WestCare will submit claims to Medicaid if you have presented a current valid card or verification of coverage has been obtained through the Department of Social Services. You may be responsible for a portion of the charges if Medicaid determines a co-payment or deductible is due.
If you are injured on the job, WestCare will bill your employer or your employer’s workers compensation carrier. In cases where Worker’s Compensation denies the claim or services received include work-related as well as non-work related healthcare services, your health insurance information will be needed. If there is no other health insurance coverage the patient will be responsible for payment of services.
Patient summary statements will be mailed after services are received, normally within 10 days. A service confirmation letter will be mailed identifying the insurance on record. If insurance information has not been provided or has changed, please contact the Patient Accounts office.
Harris/Franklin – (828) 631-9644
Swain – (828) 488-1044
Any Facility Toll Free – (866)-213-7755
After insurance has processed the claim, the responsible party will receive a bill for the balance due. Some patients are unable to pay balances in full and need an extended time to pay for services. WestCare requests responsible parties pay in full within 90 days of the balance due statement. This allows us to remain a viable community healthcare partner.
If you need to establish a payment plan, please contact the Patient Accounts office to set up the plan as mailing partial payments will not establish a payment plan.
WestCare Patient Financial Services will follow up with responsible parties to ensure all questions are answered and payments are received in a timely manner. WestCare refers accounts for external collection processes including legal avenues if the account remains unpaid.
Other Providers and Bills
The responsible party may receive additional bill(s) from physicians that provided care.
Those bills may include radiologist interpretation fees, anesthesiologist fees for administration of anesthesia during a procedure or pathologist fees for interpreting laboratory results. The responsible party should work with these individual offices for payment.
Asheville Anesthesia – 828-274-3477
Asheville Cardiology – 828-586-7451
Carolina West Radiology – 828-586-7120
Mountain Pathology – 800-528-3448
Prime Doc Hospitalists for inpatients – 800-815-7491 x239
Sylva Anesthesiology – 800-221-5630
TeamHealth Emergency Room Physicians – 888-952-6772
Physician Practices – 828-631-8206
Central Billing Office
Center for Family Medicine
Harris Emergency Medical Services
Swain Medical Center
Sylva Medical Center
Sylva Women’s Center
Provider-Based Billing Questions and Answers
Q: What does ‘provider based’ mean?
A: Provider-based refers to the billing process for services rendered in a hospital outpatient clinic or location. This status requires that the clinic bill Medicare in two parts. This is the national model of practice for integrated delivery systems where the hospital owns space and employs support personnel involved in patient care.
Q: How does being provider-based affect billing?
A: Under the provider-based model, patients may potentially receive two charges on their combined patient bill. One charge represents the facility charge and one charge represents the professional or physician fee charge. Prior to being provider-based, all charges were grouped together on your patient statement.
Q: Why move to this billing process?
A: Patients admitted to hospitals have historically received more than one bill, one for hospital services and others for physician or professional services. Following this same type of billing services ensures more appropriate payment for services provided by hospital staff and physicians and distinguishes facilities that function as departments of hospitals from those which are free-standing.
Q: Does this mean patients will pay more for services?
A: Depending on a patient’s particular insurance coverage, it is possible that patients may pay more for certain outpatient services and procedures at our provider based locations than at another site. We recommend patients review their insurance benefits or contact their insurance provider to determine what their policy will pay and what out-of-pocket expenses may be incurred.
Please Note: The total cost of charges for Medicare patients will not exceed charges incurred by non-Medicare patients receiving the same services.
Q: Does this affect patient co-pays or deductibles?
A: Depending on each patient’s specific insurance benefits, additional patient out-of-pocket expenses may be incurred by the provider-based model.
Q: What are the provider-based locations under Harris Regional Hospital and Swain County Hospital?
A: Harris/Swain/Franklin sites:
- Center for Family Medicine
- Ancillary Services of WestCareMedicalPark of Franklin
- MedWest Urgent Care – Sylva
- Mountain Care Urology
- Western Carolina Pulmonary and Sleep Consultants
Other locations will be included as we to expand services to meet patient needs.
For more information please contact us at (828) 631-8206 or (828) 631-8227 if you have further questions regarding Provider-Based billing.
Credit and Collection Practices
Insurance claims are submitted within days of service to Medicare, Medicaid, Commercial, Managed Care, Liability and all other carriers. Patients are expected to pay any known co-payments, deductibles and non-covered amounts when services are received. All requests for payment are based upon ESTIMATED amounts and are not considered final billing totals. Any remaining balances due will be billed to you once your insurance company has paid or denied. Balances are due and payable upon receipt of your statement. Insurance claims are submitted as a courtesy and do not relieve patients of financial obligations.
If a patient’s account (s) becomes past due, WestCare may pursue outside collection activity including legal action if necessary.
Itemized or summary statements are available to you upon request.
For more information, call:
Harris/Franklin – (828) 631-9644
Swain – (828) 488-1044
Any Facility Toll Free – (866)-213-7755