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PATIENTS & VISITORS

Financial Services

Contact financial services at 931-783-2360

140 W. 7th St., Cookeville, TN 38501

Do you need to pay your bill?

You have options. You can finance it, pay online, in person, by phone or by mail.

Finance your bill

By partnering with Care Payment, Cookeville Regional is able to offer patients a convenient, stress-free way to finance their out-of-pocket medical expenses.

Flexible payment options ranging from 12-48 months with no or low interest rates.

No application or credit checking, all patients are accepted.

An open line of credit that allows for additional services to be included.

http://learn.carepayment.com/CRMC

Pay your bill

We make it easy to pay your bill.

You can do it online through this link: https://crmc.mysecurebill.com/default

You can also pay your bill these ways:

By mail

Cookeville Regional Medical Center Financial Services
1 Medical Center Blvd.
Cookeville, TN 38501

By phone
931-783-2360

In person
You can pay in person at our location at 140 W. 7th St. in Cookeville.

Accepted Insurances

Aetna

  • Aetna, PPO, POS
  • Aetna Medicare Advantage
  • Aetna Select VHAN (Premier)
  • Aetna TN Preferred
  • Aetna Whole Health
  • Meritain Health

Ambetter of Tennessee (Commercial Exchange only)

  • Ambetter of Tennessee (Effective 11/1/2022)

Amerigroup

  • Amerigroup TennCare (Adult providers may require preauthorization.)
  • Amerigroup CoverKids
  • Amerivantage Medicare Advantage

BlueCross BlueShield

  • BlueCross BlueShield BlueCard
  • BlueCross BlueShield of Tennessee – Networks P, S (Includes individual exchange plans)
  • BlueCross BlueShield Medicare Advantage Plans

BlueCross BlueShield TennCare

  • BCBST CoverKids
  • BlueCare
  • BlueCare Plus Medicare Advantage & DSNP
  • TennCare Select

Bright Health

  • Bright Health (Commercial Exchange only)
  • Bright Health Commercial
  • Bright Health Medicare Advantage

Center Care

  • Center Care

Cigna

  • Cigna HMO, PPO, POS (Includes Open Access and Great West)
  • Cigna Connect
  • Cigna-(aka HealthSpring) Medicare HMO and PPO

Farm Bureau

  • Farm Bureau (commercial plan offered through UMR)
  • Farm Bureau Medicare Advantage (effective 1/1/23)

First Health

  • Coventry Health (Affordable, CCN, & Medview)

Health Payors

  • IHG HealthSmart Network

Health Plans, Inc.

  • Health Plans, Inc. (Nyrstar)

Humana

  • ChoiceCare PPO and POS (excludes local POS)
  • Humana (includes HMO, NPOS and PPO. Excludes local POS)
  • Humana Medicare Advantage HMO, PPO, POS

Multiplan

  • Multiplan (PPO, PHCS PPO; includes Beech Street, America’s Health Plan, and BCE Emergis)
  • Private HealthCare Systems (PHCS)

NHC Medicare Advantage

Novanet

  • Novanet

Prime Health Plan

  • Prime Health PPO

TRICARE

  • TRICARE East Standard and Prime (Humana Military)
  • TRICARE West (HealthNet Federal Services)
  • Tricare For Life
  • TRPN
  • TRPN PPO

Three Rivers Provider Network (TRPN) PPO

UnitedHealthcare

  • UnitedHealthcare (HMO, PPO)
  • United Core Network
  • UnitedHealthcare® Group Medicare Advantage Plans
  • United Heritage Select Advantage Plan
  • UnitedHealthcare Medicare Complete/AARP

UnitedHealthcare Community Care Plan

  • UnitedHealthcare Community Plan TennCare (Adult providers may require prior authorization)
  • UnitedHealthcare Community Plan CoverKids
  • UnitedHealthcare Dual Complete® Plans (Medicare/Medicaid)

United Mine Workers

  • United Mine Workers

USA MCO

  • USA MCO

Veterans Affairs (VA)

  • Veterans Affairs (VA)
  • Veterans Affairs (VA) Community Care Network (via Optum)

WellCare TN (formerly known as Harmony)

  • WellCare Medicare Advantage

Your rights and protections against surprise medical bills

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 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 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 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.

When you get emergency care or are 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.

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:

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 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 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 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.

When you get emergency care or are 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.

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, please call Cookeville Regional Medical Center’s Patient Financial Services at 931-783-5350. You may also contact the federal No Surprises Help Desk at 1-800-985-3059.

You may 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.

  • 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.

For questions or more information about your right to a Good Faith Estimate, please call Cookeville Regional Medical Center’s Patient Financial Services at 931-783-5350.

You may also contact the federal No Surprises Help Desk by visiting www.cms.gov/nosurprises/consumers, emailing FederalPPDRQuestions@cms.hhs.gov, or calling 1- 800-985-3059.

Estimating your cost of care

We want to make the cost of your care easy to understand, which is why we established a price transparency website. This website is here to help you understand and plan for your health care costs.

Our online cost estimate tool helps you estimate the hospital fee for your inpatient or outpatient care at our hospital. It is easy to use. Just put in the procedure, your insurance company and plan and search.

The estimate is for hospital fees only. Hospital fees include the cost of your room and supplies for your medical service.

https://pricing.crmchealth.org/

This is not a complete estimate of your care cost.

The estimate does not include physician or provider fees, such as anesthesia, radiology, pathology or emergency room doctor, or the cost of medication, medical equipment and homecare services.

Your actual charges may be different from the estimated charges. This all depends on the services you receive and the coverage provided by your insurance plan(s).

Charity Care Policy

  1. COOKEVILLE REGIONAL MEDICAL CENTER SERVICE AREA – the following list of counties in the Upper Cumberland area comprise the service area: Putnam, Jackson, White, Cumberland, Warren, Van Buren, Cannon, Fentress, Overton, Pickett, Smith, Clay, Dekalb, and Macon. Cookeville Regional reserves the right to add to or subtract from the list of counties in its service area.
  2. INCOME – Any income, whether from active or passive activities, such as rental, social security, disability, retirement, alimony or child support, unemployment benefits, inheritance, investments, annuity payouts, gifts or fund raisers. It also includes proceeds from sale of long-term assets or the proceeds from life insurance, third party settlements or lump sum annuity payments.
  3. PATIENT MAXIMUM LIABIITY – Amount of total patient liability for patients at 200% of the poverty level or below will not exceed 10% of total household income.
  4. FEDERAL POVERTY LEVEL – the most current federal poverty guidelines from the U.S. Center for Medicare and Medicaid Services (CMS)

CHARITY CARE FINANCIAL ASSISTANCE

  1. Cookeville Regional will provide medically necessary hospital services, including emergency room services to patients and for those eligible under this policy based upon their family income will discount their maximum liability of total charges after the state mandated discount based upon the following scale:
  2. 100% or below Federal Poverty Level 100% discount
  3. 101-150% of Federal Poverty Level 75% discount
  4. 151-200% Federal Poverty Level 50% discount
  5. 201-300% Federal Poverty Level 25% discount
  6. 301% and above Federal Poverty Level no discount

Cookeville Regional’s policy is to provide medically necessary health care services for patients in its service area as defined by Cookeville Regional. The intent of this policy and related procedures is for use in circumstances in which financial assistance shall be offered to Cookeville Regional patients who have no insurance coverage or inadequate insurance coverage and who are unable to pay in full for their health care services and who meet the eligibility criteria set forth in this policy. While it would be ideal for Cookeville Regional to provide health care services to all without regard to payment, it is financially impossible to do so. This policy applies not only to inpatient services but to outpatient services provided by Cookeville Regional.

  1. Remaining balances from eligible patients who qualify for the above discounts may be set up on payment arrangements in accordance with Cookeville Regional’s payment plan policy. If said payments are not made on the balance of the account, it will be sent to the collection agency for follow up.
  2. Charity care assistance will not apply to accounts with a combined total less than $500.
  3. This policy only applies to patients who reside in Cookeville Regional’s service area as defined within this policy.
  4. This policy only applies to patients who are not insured through a third party or who are unable to pay in full the balance of their account after exhaustion of all third party liability.
  5. Cookeville Regional Charity care financial assistance is applicable only to items and services defined as “covered items and services” covered by the Medicare program.
  6. This policy is not applicable to any professional fees unless performed by a physician employed by Cookeville Regional or contracted to perform services for Cookeville Regional from which Cookeville Regional receives the revenue.
  7. This policy applies only to those individuals who cooperate fully with Cookeville Regional’s request for information with which to verify patient’s eligibility, including appropriate identification. It is the patient’s responsibility to respond truthfully and completely to Cookeville Regional’s request for information within a timely fashion. In addition, patient’s full cooperation in applying for Medicaid or coverage by other governmental programs is required, if so requested.

PROCEDURE

  1. Cookeville Regional personnel will provide patients with an application for Charity Care once a patient is identified as potentially eligible for charity care. The timing of the delivery of the application will depend upon when the identification is made and may be at the time of service, during the billing process or during collection. The patient must complete the application for charity care and provide all the requested information.
  2. A patient who requests the discount as an uninsured patient will not be entitled to receive the billing information that would allow them to file an insurance claim.
  3. Documentation must include the completed application, all supporting material, a print out of the account face sheet with all patient demographics and a financial analysis work sheet. In evaluating a patient’s need for charity care, Cookeville Regional personnel may review the patient’s W-2 (or the guarantor’s) tax return, paystubs, bank statements, written verification of wage from employer, written verification of public welfare

agency, governmental agency or other information attesting to the patient’s income status. Patients must provide information relating to possible third party liability incidents, where applicable, including accident reports and copies of vehicle insurance policies.

  1. Completed applications shall be sent to the department director for approval. If the dollar amount exceeds $5,000 it requires approval for the CFO or his/her designee.
  2. Once eligibility has been determined, patient will be notified of the determination.
  3. If a patient presents for treatment, regardless of their service type (cosmetic excluded), and they have been granted financial aid in the previous three (3) months, they are allowed to move forward with the services their physician has ordered without administrative approval.
  4. Documentation for the outstanding charity monthly accrual is forwarded to accounting by the 4th working day of the month for the previous month’s accrual.
  5. EXCEPTIONS
  6. Cookeville Regional reserves the right to grant financial assistance in extraordinary circumstances to patients who do not otherwise meet the charity care guidelines. Cookeville Regional also reserves the right to deny charity care assistance to patients who fail to cooperate with Cookeville Regional’s efforts to verify eligibility, provide false information, refuse to apply for Medicaid or other governmental program benefits or who fail to respond to requests for information in a timely fashion.
  7. Uninsured patients who do not qualify for charity care or who do not wish to be considered may be offered a prompt pay discount of 25% for payment in full within 60 days of discharge date.