Community Medical Centers’ MyHealthMate electronic health record is an easy, confidential way to access your medical information online. Through MyHealthMate you can:

• View and pay your hospital/doctor billing statements

• Request medical appointments

• View your health summary

• Access test results

• Request prescription refills

• Communicate with your doctor

Costs may vary based on your insurance benefits, the specific procedures, supplies or tests you need, and the type of facility in which a procedure is performed. In some cases, services may cost less if provided outside a hospital setting, such as in an outpatient surgery center. Please work directly with your physician to identify the most appropriate care setting and treatment plan for you.

You should contact your health plan directly before an anticipated hospital procedure or admission. You can find your plan’s customer service phone number on your insurance card. Our hospital staff can also provide a general estimate of your out-of-pocket costs at our facility. Please call our Patient Pre-Registration line at (559) 459-5734.

• Co-payment (co-pay) is a specific or fixed dollar amount you pay when you receive certain covered services. This is paid at the time service is received, as determined by your insurance plan. Example: $100 due for each visit to the Emergency Department.

• Co-insurance refers to the percentage of the cost you must pay for certain covered services. The insurance company pays a certain percentage of covered expenses and the patient pays the remainder.

• Deductible is the amount you must pay for certain covered services, each calendar year, before the insurance plan starts to pay any benefits.

• Out-of-Pocket Maximum is a predetermined amount of money you must pay before an insurance company will pay 100% of your healthcare expenses.

An EOB is an Explanation of Benefits. After you've received services, a claim is submitted to your health plan to request payment for services. After the claim has been processed, the health plan sends you an EOB. An EOB contains total charges billed to the health plan, the allowed charges, payment to the provider and the amount of patient responsibility. The allowed charges indicate the negotiated rate between the provider and the health plan.

Physicians and hospitals keep separate health insurance information, since physicians are not employed by the hospital. Also, physicians keep their own patient information, because your health insurance coverage may be different for a physician visit than it is for hospital services.

If you're scheduled for a surgery or procedure, a representative from the hospital may provide you with an estimate of what your out-of-pocket expenses may be. Keep in mind this is just an estimate based on the information available.

If you're insured, it will also be based on your insurance coverage, any remaining due on your deductible, the amount of your co-insurance, and our contract with your insurance company.

Once we receive a payment or denial from your insurance company, you'll receive a statement showing the amount that's due from you. This amount should be the same amount noted on the Explanation of Benefits (EOB) you receive from your insurance company.

If you have questions, please contact your insurance company or Patient Financial Services at the number located on your billing statement. If your estimate was too high, and you don’t have any other balance due, we'll send you a refund for the amount you overpaid.

When someone comes to the emergency room, it's implied that they have a medical emergency. Specific federal regulations like the Emergency Medical Treatment & Labor Act (EMTALA) require that emergency room clinicians first see the patient before we can discuss any financial questions.

We understand this restriction can be frustrating. However, the regulations are there to ensure everyone who comes to an emergency room will be seen regardless of their ability to pay.

Once you've been medically evaluated and stabilized, you'll be asked to pay your co-payment, deductible, co-insurance or deposit by someone from our admitting department.

Protection against surprise medical bills

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.

California law protects enrollees in state-regulated plans from surprise medical bills when an enrollee receives emergency services from a doctor or hospital that is not contracted with the patient’s health plan or medical group. In covered circumstances, providers cannot bill consumers more than their in-network cost sharing.

View more information about the No Surprises Act.

Community Medical Centers will bill the health insurance company on your behalf. If the billing statement is unpaid because the insurance company states you no longer have health insurance coverage, we'll send you a billing statement. If you've changed insurance companies, contact us as soon as possible so we may change the information on file and bill the account correctly.

If your health insurance coverage is through Medi-Cal, a health maintenance organization (HMO) or Workers' Compensation, you may not receive a billing statement. If your bill is denied or your HMO determines that a portion of the billing statement is a patient responsibility, you will receive a billing statement.

Unfortunately, under a provision called Coordination of Benefits, the hospital is required to bill the insurance that would be considered primary for you. Any health insurance for which you're the primary subscriber must be billed before any other health insurance.

While each insurance company is different, we generally expect full payment from your insurance company within 45 days of billing. Once we receive a response from your insurance company, we determine how much you owe and you're sent a billing statement.

Other causes for delay can be due to an incorrect address or a recent move, so it's important to contact the billing office to update your current address and other personal information.

The amount that's due from the patient is rarely based on the total charges for the account, so the itemized billign statement may be of little use to you. Most insurance companies pay at a reduced rate from the total charges. The patient's amount is then based on this reduced rate. If you'd like an itemized statement, please contact the number on your statement or call Patient Financial Services at (559) 459-3939 or (800) 773-2223 ext. 53939 for help.

"Adjustment" refers to a discount that your insurance and the hospital or doctor have agreed to write off. Insurance companies pay hospital charges at a discounted rate. The amount of the discount is specific to each insurance company. 

When the insurance company pays their portion, the discounted amount (adjustment) is taken off to show the true amount due from the patient (co-insurance).

For example, a hospital may charge $10,000 for a surgery that your insurance has agreed to only pay $2,500. Of that $2,500, the patient would have to pay $500 if the patient's responsibility is 20%. After the insurance pays $2,000 and the patient pays $500, the remaining $7,500 would be the adjustment.

Please note that you may receive more than one billing statement for services received at the hospital. Doctors are independent of the hospital and bill for their services separately. For example, you may receive a billing statement from your physician, radiologist, anesthesiologist, cardiologist and pathologist. Doctors are also required to bill on a different form than the hospital and sometimes even bill different offices at your insurance company.

In the State of California, if you do not have insurance or have high medical costs you may also qualify for a discount on your physician’s statement from your emergency room physician. Please call the number on the doctor's billing statement for any questions or assistance.

Community Medical Centers has a long history of giving back to the community offering free and discounted care to families that need it most. If you need help paying your billing statement, you may qualify for a government-sponsored program or Financial Assistance that may cover some or all of your balance.

To determine if you qualify for Financial Assistance, please contact Patient Financial Services at (559) 459-3939 or (800) 773-2223 ext. 53939, or call the number listed on your billing statement.

Yes. If you'd like to set up a payment plan, please call Patient Financial Services at (559) 459-3939 or (800) 773-2223 ext. 53939 or contact the phone number listed on your billing statement.

An Advance Beneficiary Notice (ABN) is a written notice and can come from a physician, provider or supplier before they provide a service or item to you, notifying you:

• That Medicare may deny payment for the specific service or item

• The reason the physician, provider or supplier expects Medicare to deny the payment

• That you may be personally and fully responsible for payment if Medicare denies payment

• That you can refuse to receive the service or item

For more information on Medicare, go to www.medicare.gov.

For more information on Medi-Cal, go to www.medi-cal.ca.gov.

For more information on Covered California, go to www.coveredca.com.