Insurance Information

Saint Michael's Medical Center is considered a network participant with many insurance companies, including those that are part of the Health Care Exchange (Affordable Care Act).

Pre-Certification

Your insurance or managed care plan may require you to obtain pre-certification or pre-authorization for hospitalization, a procedure, surgery or service before they can be provided by the hospital and health care provider. Be certain to check this pre-certification requirement before your admission.

If you were admitted to the hospital through the emergency department, be sure that your insurance company is immediately notified of your admission. If you have any questions, please contact your insurance company or speak to a Saint Michael's representative.

You will probably receive more than one bill for services rendered by the hospital. Usually, one bill is sent for the use of hospital equipment, supplies, your room and board, and the time the nurses and other staff spent meeting your health care needs. You are responsible for any charges not covered or approved by your medical insurance company or managed care organization.

The hospital bill does not include fees of any treating physicians. (see below)

Participating Insurance Plans

The below list of commercial insurance plans that we contract with should not be considered comprehensive. Patients should always check with their individual carriers to determine the network status of Saint Michael's.

• Aetna Commercial
• Aetna Medical Rental (Third Parties First Health)
• Horizon BC HMO/PPO/Indemnity
• Qualcare Commercial HMO/POS/PPO
• United Healthcare All Payer/Oxford

This list only reflects the insurers and managed care organizations that have contracts with Saint Michael's Medical Center. This list may not be comprehensive. For example, specialty insurers such as worker's compensation and personal injury protection ("PIP") are not included because there are a number of different types of insurance products and we may not participate in all of them. If you do not see your plan listed on our website, we strongly recommend that you contact us or your health insurance plan to confirm whether your plan is in-network or out–of-network with our facility.

Health Care Exchange Products

Saint Michael's participates in select Health Care Exchange (Affordable Care Act) insurance plans. Please note that these products may have an associated network of preferred providers, and as such, your benefits and potential out-of-pocket expenses may vary depending upon where and by whom care is provided. It is strongly recommended that you contact your plan in advance of seeking services in order to understand your potential financial liability.

While Saint Michael's participates in many health care plans, it is important to recognize that physicians are NOT employees of the hospital and may or may not participate in the same health insurance plans in which the hospital participates. You should check with the physician who is arranging your healthcare services to see which insurance plans the physician participates in. You should also know that the cost of these healthcare professionals are not included in the hospital's charges. All doctors charge separately for their services and bills received from those doctors are separate from any bills from Saint Michael's. .

Physicians and Physicians Groups We Employ

Click here (coming soon) to see a list of the physicians or physician groups that are employed by Saint Michael's. While the physicians are hospital employees, you may still receive a separate bill for their services in the event they process their own billing.

Physicians and Physicians Groups With Whom We Contract

Saint Michael's contracts with several hospital-based physician groups (e.g., anesthesiology, pathology and radiology) to provide services to patients. Please contact your insurance company to verify network status for these independent providers. Click here to see a list of the physicians and physician groups that are contracted with Saint Michael's. You should also know that these healthcare professionals’ costs are never included in the facility’s charges. They will bill you separately.

You should check with the physician who ordered the healthcare services and ask whether the physician is in network or out of network with your health insurance plan. You should also ask if there are additional physicians who may be involved with your care.

If a physician is in network, you should never be charged more than your in-network copayment, coinsurance or deductible.

If an in-network provider charges more than your in-network copayment, coinsurance or deductible, you should notify your health insurance plan and the Department of Banking and Insurance/Department of Health.

If you have any questions about insurance or out-of-network benefits, please contact us between 8 a.m. and 5 p.m. at 973-877-5000 and dial 4 for Admitting.

Additional Disclosures – In-network

Because Saint Michael’s Medical Center is in network, you will not pay more than your in-network copayment, coinsurance or deductible for the hospital’s services.

If Saint Michael’s Medical Center’s network status changes with your health insurance plan prior to your scheduled appointment, Saint Michael’s Medical Center will notify you.

Additional Disclosures – Out-of-network

Because Saint Michael’s Medical Center is out of network, you may pay more than your in-network co-payment, coinsurance or deductible for the services received or performed at this facility.

You may be responsible for any difference between what your insurance company pays Saint Michael’s Medical Center for the service and what Saint Michael’s Medical Center charges.

If you wish to receive services at Saint Michael’s Medical Center, first please contact your insurance company to determine if you have an out-of-network benefit option. If you do, you should ask what your potential out-of-pocket costs may be and double-check that your services will be covered. If you do not have an out-of-network benefit option, you will be responsible for all charges.

Additional Disclosures – Self-funded Plans that did not opt-in

You have a health insurance plan that is self-funded.

Self-funded insurance plans are not required to follow the “Out of Network” law.

We must advise you that any services you receive at Saint Michael’s Medical Center may be out-of-network with your health insurance plan.

Because of this, you may pay more than your co-payment, coinsurance or deductible for services received or performed at this facility.

You may also have to pay the balance above any amount that your insurance plan paid for the services.

If you wish to receive services at Saint Michael’s Medical Center, please contact your insurance plan to find out if you have an out-of-network benefit option. If you do have an out-of-network benefit option, you should inquire about your potential out-of-pocket costs and double-check that the healthcare services will be covered. If you do not have an out-of-network benefit option, you will be responsible for all charges.