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).
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
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
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 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
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.