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Billing

For more information about payment options or to determine if you qualify for Medical Assistance, call the Billing Office at 354-2383

 

 

Billing Statement

 

1 Name and Address of responsible party
2 Address for remittance and name to make payment to
3a Account Number (Please place on check)
3b Date services reflected through (Services or payments received following this statement date appear next month)
3c Total payable from patient and Insurance pending
4 Credit card type (Please fill out completely)
5 Date of Service, payments received or service charges
6 Description of service. (Includes patient and admission number, patient name, type of visit, detail of payment or interest)
7 Total amount charged and/or interest accumulated.
8 Payment considered, adjustment or write off amount.
9 Amount pending for insurance consideration.
10 Total balance due from patient regardless of insurance pending.
11 Message of the month (Look for a new message each month)

 

 

Payment Options

Teton Valley Hospital & Surgicenter honors most major insurance carriers including Blue Cross, Blue Shield, Medicare and regional Medicaid.

Private pay patients should be prepared to pay in full at the time of service, or make payment arrangements with our Patient Account Representatives prior to admission.

Insurance coverage is a contract between the patient and their carrier. Patients are responsible for all hospital charges incurred. Insurance billing is a courtesy provided by our Billing Office.

Patients in need of financial medical assistance are encouraged to apply to one of many available federal, state and county programs before receiving care. If emergency care is required, Medical Assistance programs may help cover costs.

Remember to contact your insurance company prior to any scheduled hospital stay. A pre-admission review for hospital stays over 24 hours may be required, and failure to obtain one may affect your benefit payments.

 

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