No Surprises Act
Centers for Medicare & Medicaid Services (CMS) has instituted regulations to protect patients from surprise medical bills. More details on the No Surprises Act can be found at https://www.cms.gov/nosurprises. The No Surprises Act protects patients with insurance through an employer, individual health plan or Health Insurance Marketplace from balance billing for designated services. Details of these balance billing protections can be found in this CMS Disclosure (PDF). Patients with no insurance will be provided a good-faith estimate for pre-scheduled appointments.
Disclosure for Good Faith Estimate (PDF)
Disclosure Rights and Protections Against Surprise Medical Bills (PDF)
Tomah Health’s Estimate Generator
You are able to create an estimate for the cost of your care or the amount you might owe for your care, please contact our patient financial services department at 608-377-8640 or use our online estimator to estimate your cost now.
Patients who are unable to pay for hospital service are welcome to apply for the hospital’s financial assistance program. Applications are available in Patient Financial Services, or by calling toll free at (855) 778-2923 or (608) 377-8640. Eligibility is based on household income, family size, amount of medical debt and the financial resources of the household.
Federal poverty income guidelines are used as the basis for eligibility. Our Financial Assistance program involves only hospital charges. Some services provided by the hospital are not included in this program. In addition, physician’s fees from the clinics are not included in the hospital’s program. If you wish to seek assistance with their bills, you will need to work directly with the physicians or their office staff.
Financial Assistance Policy Plain Language Summary (PDF)
Financial Assistance Policy (Complete)(PDF)
Financial Assistance Application (PDF)
The Wisconsin Hospital Association Information Center, LLC (WHAIC), a subsidiary of the Wisconsin Hospital Association, provides a web-based resource that provides hospital-specific charges and financial data related to care provided in all Wisconsin hospitals, urgent care settings owned by hospitals and in Medicare-certified ambulatory surgery centers in Wisconsin.
Tomah Health Patient Financial Office
The Tomah Health Patient Financial Services Office is located at 501 Gopher Drive in Tomah and open Monday – Friday 8 am – 4:30 pm
- Telephone Assistance, please call (608) 377-8640 OR toll free at (855) 778-2923 or Email PFS@tomahhealth.org
- Monday – Tuesday 8 am – 6 pm
- Wednesday – Friday 8 am – 5 pm
When you seek services at Tomah Health, we ask that you accept responsibility for payment for those services in a timely manner. We will bill Medicare, Medicaid or your insurance for services provided. You will be required to sign a Consent for Treatment and Responsibility for Payment form regardless of third party insurance coverage. Your account is your personal responsibility. If any portion of your account is not covered by insurance, please contact Patient Financial Services to make other financial arrangements.
The Hospital’s general billing and collection guidelines can be found in the “Management of Accounts Receivable” policy (PDF).
This policy provides information regarding the submission of claims to third party payers, management of self-pay accounts, and the steps taken prior to submitting a delinquent account to an external collection agency.
Insurance and HMO Information
Tomah Health participates in many of the managed care plans offered in the area. If you have a question as to whether or not we participate in the plan you have, please check your provider directory or call your insurer.
It is very important for you to know if your insurance or HMO/PPO requires pre-certification for any care provided at the hospital. If pre-certification is required and you or your physician do not takes steps to insure this authorization is obtained, you will be responsible. Failure to obtain prior authorization can result in reduced benefits or the possible denial of your entire claim.
If you have insurance or HMO/PPO coverage, Patient Financial Services Office will bill your insurance if complete billing information was given at the time of registration/admission. You will be notified by letter if your insurance carrier or HMO/PPO does not pay the bill promptly or if there is a balance remaining after the insurance or HMO/PPO payment. If you have questions regarding payment, we suggest you contact your insurance carrier or HMO/PPO to review the status of your claim. If you have any other questions, please call Patient Financial Services.
Tomah Health is a participating provider for Medicare and accepts assignment of covered benefits. After Medicare pays their portion of the charges, the hospital billing office will bill your supplemental insurance based on the information you provided during the registration process. You will receive a statement from the hospital notifying you of your responsibility if there are any balances after Medicare and your supplemental insurance payments.
Most Commonly Used Languages
To assist those with limited English proficiency, explanations about the availability of language assistance (PDF) has been translated into the most commonly used languages in our area.
If your insurance company does not pay in full, you will receive a statement notifying you of your balance. In addition to payment by check or money order, we do accept MasterCard, Visa, or Discover Cards. If you are unable to make payment in full, depending upon the balance due, the hospital may offer a short-term payment plan. You will need to contact Patient Financial Services at (608) 377-8640 to work with them.
Delinquent accounts will be referred to outside collection agencies when payment in full has not been received or appropriate payments plans have not been established.
If you are pre-scheduled for a test or procedure and do not have insurance, you may be asked to pay all or a portion of the expected charges prior to the procedure with the balance of the charges due within 60 days after the procedure.
As a cost savings measure, we do not routinely send out copies of itemized patient bills. The statement you receive is a summary of charges. Should you desire an itemized statement, please contact Patient Financial Services and one will be sent to you within 2 business days. If you are a patient at the hospital multiple times, you may receive separate statements for each visit.
Your Hospital bill will not include charges for any physicians who provide services directly to you or on your behalf. Each physician involved in your care will bill you separately for services provided. The amount due to your physicians is in addition to your hospital bill. Questions concerning physician’s fees should be directed to their billing offices.