Payment & Insurance
Eastern State Hospital files insurance claims as a courtesy to you.
We are a preferred provider in many managed care and health insurance plans. Please make sure we are on your insurance carrier's list of participating hospitals. If we are not, you may be financially responsible for your bill.
If Eastern State Hospital is not on your list of participating hospitals, it is still possible to access our services; you will need to get proper approval from your health plan. While Eastern State Hospital strives to ensure that this list is current and accurate, frequently there are changes in the plans participating with Eastern State Hospital. Inclusion on this list does not guarantee payment by the insurance company.
Billing
Eastern State Hospital will bill you or your insurance carrier for non-physician or facility charges such as room and board, nursing services, laboratory services and medical supplies.
Eastern State Hospital utilizes an “Ability to Pay” system. Uninsured patients must contact a hospital representative to submit required financial documentation in order to have charges calculated using the “Ability to Pay” System.
Financial documentation is used to calculate an estimated amount that the facility would charge the patient for care. This is based on the patient’s unique financial situation, therefore, would be specific only to you as the patient who received care.
Physician Billing
Eastern State Hospital will bill you or your insurance carrier for any services you receive from physicians.
Hospital Billing
Eastern State Hospital will bill you or your insurance carrier for non-physician or facility charges such as room and board, nursing services, laboratory services and medical supplies.
For questions about your bill, to request an itemized statement or to discuss Eastern State Hospital’s “Ability to Pay” financial assistance program:
Call patient billing to speak with a financial counselor 859-246-8000, Mon.-Fri., 8 a.m. - 4:30 p.m.
Patient itemized statement request form can be completed and faxed to 859-246-8043 for processing.
Requests in writing may be sent to:
Eastern State Hospital
1350 Bull Lea Road
Lexington, KY 40511
Pricing
The Centers for Medicare and Medicaid Services (CMS) pursuant to the Federal Executive Order and Pricing Transparency Final Rule requires hospitals to make available online a listing of standard hospital charges. In addition, the CARES Act necessitates the carve out of COVID-related pricing. In adherence to these requirements, Eastern State Hospital is making this information available via the link below.
Patient education and participation as to the cost of health care is important to us. We encourage patients to contact our patient billing and financial counseling department at 859-246-8000.
Surprise Billing
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 balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or a deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You’re 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 they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). 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 balance 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 can 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 types of 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 out-of-network care. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have these protections:
- You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
- Generally, your health plan must:
- Cover emergency services without requiring you to get approval for services in advance (also known as “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 in-network deductible and out-of-pocket limit.
If you think you’ve been wrongly billed, contact the Federal No Surprises Helpdesk at 1-800-985-3059.
Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost
Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.
- You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
- If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate and the bill.
- Click here to access our consumer shoppable services