Insurance

  • Raritan Bay Medical Center is contracted with most insurance plans. As a courtesy to our patients, we will submit our bill directly to your insurance carrier if one was provided upon admission. If you are covered by more than one insurance carrier, please provide the necessary insurance information along with copies of your insurance cards at the time of registration. If you are enrolled in a Medicaid Managed Care plan, please provide a copy of both your Medicaid card and your managed care ID.
  • If your admission is a result of a motor vehicle accident or from a work-related injury, you are required to provide us with an insurance claim number along with the insurance carrier information.
  • It is your responsibility to provide us with complete coverage information, such as name, address and contact information for the responsible carrier (i.e. motor vehicle insurance and/or worker’s compensation) to include a claim number. These claims must be initiated by you or your designee. This is done in an effort to prevent you from being completely responsibly for the entire claim.

Patient/Guarantor Responsibility

  • As a patient or the guarantor of the patient, it is important that you supply Raritan Bay Medical Center with complete and accurate insurance information.
  • It is important to remember that as the patient or the guarantor, you are responsible to notify your insurance carrier immediately of your admission and to comply with their policies concerning referrals and authorizations.
  • Many carriers will periodically update their files regarding coordination of benefits (cob), pre-existing conditions and your dependents school status prior to making payment on medical claims. It is important that you provide this information, if requested, in a timely manner.
  • In the event of an emergency admission, appropriate medical screening and treatment will not be delayed to verify your insurance information or your ability to pay.

What is included in your Hospital Bill:

  • When you are treated in the hospital, the hospital bills for the use of the equipment, supplies, your room and board, etc., and the technical part of the ancillary testing. In addition to the hospital bill, you may also receive a bill from your primary physician, the emergency room physician or other physician groups involved in your treatment or for the professional reading of diagnostic tests.
  • Hospital reimbursement is determined by Medicare, Medicaid, billed charges or it is based upon a contracted rate with the insurance carrier. These parties do not pay for hospitalizations that are not medically necessary. Upon determination that the hospitalization is NO longer medically necessary, you and your physician will be notified as required by state and federal regulations.

FINANCIAL ASSISTANCE GUIDE

Raritan Bay Medical Center (RBMC) prides itself on the quality and care we provide to our community.  RBMC must charge and bill for all services rendered to our patients. The amount of the total charges will be dependent upon the extent of the services ordered and provided by your doctor and clinical team.

RBMC is contracted with most insurance plans. As a courtesy to our patients, we will submit our bill directly to your insurance carrier if one was provided upon admission. If you are covered by more than one insurance carrier please provide the necessary insurance information along with copies of your insurance cards at the time of registration. If you are enrolled in a Medicaid Managed Care plan please provide a copy of both your Medicaid card and your managed care card.

If you are uninsured or your insurance doesn’t cover all of the costs of your medical stay, there are Federal and State sources of financial assistance that you may qualify for. Our Financial Counselors are available to discuss with you what assistance you may qualify for, as the eligibility requirements of these plans are not all the same.

  • Financial Counseling maybe reached by calling: 732-324-5229
  • Financial Counseling office hours: 9am to 1pm Monday through Friday (located on the concourse level in the Perth Amboy campus)

Aside from the programs listed below, Raritan Bay Medical also provides a self pay discount to those patients that do not qualify for financial assistance and are uninsured. Eligibility for the programs below are dependent on the income and asset criteria defined by the State of New Jersey. When you meet with one of our Financial Counselors, you will be provided with a detailed list of what you will need.

New Jersey Medicaid

In addition to our own Financial Counselors, Raritan Bay Medical Center has an on-site Middlesex County Medicaid representative and has also contracted with an outside company, CBIZ-KA Consulting Services, LLC, to assist our patients who meet the NJ Medicaid eligibility criteria, with the application process. There are many types of Medicaid available through the State of NJ

NJ FamilyCare

NJ FamilyCare is federal and state funded health insurance program created to help qualified New Jersey residents of any age access to affordable health insurance.

Who is Eligible for NJ FamilyCare?

Beginning October 1, 2013, new federal rules changed Medicaid eligibility. NJ FamilyCare will include: children, pregnant women, parents/caretaker relatives, single adults and childless couples. Financial eligibility will be determined by the latest federal tax return which, when filed, will be electronically verified.

  • Children 18 and under will continue to be eligible with higher incomes up to 350% FPL Parents still need to renew the coverage each year.
  • Parents/Caretaker Relatives with income up to 138% FPL – must have tax dependent children in their household in order to be eligible under this category. This is a new Medicaid Expansion eligibility group. Dependent children in the household must be insured also.
  • Adults without dependent children with ages 19-64 and incomes up to 138% FPL are considered to be another new Medicaid Eligibility Expansion Group.
  • Pregnant Women up to 200% FPL: there are no changes to pregnant women.
  • Aged, Blind or Disabled programs or Long Term Care, there are no changes in eligibility.

Medical Emergency Payment Program for Undocumented Residents

This program will pay for emergency care provided by a hospital for people who would have been eligible for NJ FamilyCare/Medicaid but do not, due to their immigration status. The care must be for medical conditions that happen suddenly with severe symptoms that will cause a serious health problem if immediate medical attention is not provided.

If care is received in a hospital for a condition meeting the above criteria, the hospital, physicians’ and other related costs (including ambulance service) may be covered by this program.

Our Financial Counselors, CBIZ staff or our County Outreach worker can assist you with enrollment in the NJ FamilyCare Program. The enrollment process can also be completed entirely in your own home. By calling 1-800-701-0710 and giving your name and address, an application will be mailed to your home*, or you can download the application or apply online by going to the State’s website:

http://www.njfamilycare.org/apply.aspx.

Presumtive Eligibility – Medicaid

Presumptive Eligibility (PE) for NJ FamilyCare offers temporary medical insurance for services provided by participating providers while NJ FamilyCare applications are pending an eligibility determination. Certified staff within acute care hospitals, federally qualified health centers (FQHCs), primary care provider offices and local health departments can “presume eligible” an uninsured patient presenting for care who appears to meet income and other eligibility requirements. Support documents are not needed for PE to be established.

New Jersey Hospital Care Payment Assistance (Charity Care)

The New Jersey Hospital Care Payment Assistance Program (Charity Care Assistance) is free or reduced charge care which is provided to patients who receive inpatient and outpatient services at acute care hospitals throughout the State of New Jersey. Some services such as physician fees, anesthesiology fees, radiology interpretation fees, and outpatient prescriptions are separate from hospital charges and may not be eligible for reduction.

Unlike Medicaid and NJ FamilyCare, which provides ongoing coverage for health care services, including physician services and drugs, Charity Care is designed to provide assistance to cover the costs of medically necessary hospital services only. In addition to our own Financial Counselors, RBMC has contracted with Self Pay Solutions (SPS) to assist our patients with the Charity Care process.

Who is Eligible for Charity Care?

Hospital care payment assistance is available to New Jersey residents who:

1. Have no health coverage or have coverage that pays only for part of the bill: and

2. Are ineligible for any private or governmental sponsored coverage (such as Medicaid); and

3. Meet both the income and assets eligibility criteria.

(Charity Care is also available to non-New Jersey residents, subject to specific State provisions)

 

Income as a % of HHS Poverty Income Guidelines

Patient Responsibility

less than or equal to 200%

0%

greater than 200% but less than or equal to 225%

20%

greater than 225% but less than or equal to 250%

40%

greater than 250% but less than or equal to 275%

60%

greater than 275% but less than or equal to 300%

80%

greater than 300%

100%

 

In order to apply for Charity Care you must have a scheduled appointment for services within our hospital within 30 days or have received a hospital bill within the last 12 months.

It is the patient’s responsibility to complete the charity care application and supply all requested documents to the Financial Counselors’ Office. Please notify the registration team member when you have been approved for any service such as Charity Care or Medicaid.

Health Insurance Marketplace: Enroll for 2015 Healthcare Coverage

Use the ‘healthcare.gov‘ link  to access the Insurance Marketplace website.  The Health Insurance Marketplace helps uninsured people enroll in health coverage. Fill out the Marketplace application to find out if you qualify for private health insurance with savings based on your income. Plans cover essential health benefits, pre-existing conditions, and preventive care. Most people who apply through the Marketplace qualify for premium tax credits and savings on out-of-pocket costs based on household size and income. Or you may qualify for Medicaid and the Children’s Health Insurance Program (CHIP). These programs provide free or low-cost coverage to millions of families with limited income. Many states, including New Jersey have expanded Medicaid to cover more people.

https://www.healthcare.gov