Registration and Billing FAQs and Terms

REGISTRATION

Do I have to stop at Registration every time I visit the hospital?

The service or treatment you will be receiving will determine if you need to stop at registration. If you are scheduled for your services ahead of time, you do not need to stop at registration. However, if you are having lab work, EKGs, or x-rays done on a walk-in basis, you must stop at registration. This process enables St. Clair to confirm that both your demographic and insurance information has not changed and, if necessary, update our records if there have been changes since your last visit.

Do I have to schedule in advance to have outpatient testing completed?

The services you will be receiving will determine if you need to schedule an appointment. Lab work, electrocardiograms (EKG), and x-rays are done on a walk-in basis and do not need to be scheduled, however you can call ahead to pre-register by calling 412.942.8152. All other testing must be scheduled in advance by calling 412.942.8150.

How do I pre-register for lab work, x-ray, or an EKG?

Call our pre-registration department at 412.942.8152 between 8:00am – 4:30pm Monday – Friday. Please call the day before you expect to visit, and please call on Friday to register for Saturday or Monday. When you call please make sure to have your script and insurance information available.

How do I schedule a test ordered by my Physician?

Call our scheduling department at 412.942.8150 between 8:00am – 6:00pm Monday – Friday. For Nuclear Medicine testing, call 412.942/3220. Before calling, please make sure to have your script and your insurance information available for the scheduler to better assist you.

Press option 1, and then option 4 for medical imaging tests including:

  • CT scans
  • Ultrasound
  • MRI
  • Fluoroscopy, ex. barium swallow tests
  • Mammography
  • Dexa scans, i.e. bone density tests

Press option 2 for heart center testing including:

  • Echo
  • Electrocardiogram (EKG/ECG)

Press option 3 for neurology testing including:

  • Electromyography (EMG)

Press option 6 to schedule Sleep Center testing.

How much will my test cost?

To obtain an estimate online, click HERE. To obtain an estimate over the phone from one of our Financial Associates, call 412.942.8228 between 8:00am and 4:30pm Monday – Friday.

How do I obtain my results?

Patients can view their test results through the St. Clair Hospital Patient Portal. Patients can also complete an Authorization form to have their results mailed to them, or request a disk with their results at the time of service. After services are completed, patients can also call 412.942.8150, press option 1, and then option 2 to have a disk made for them with results.

How do I sign up for the St. Clair Hospital Patient Portal?

Patients can sign up for the Patient Portal by providing an email address at the time of registration. An email will be sent to the address provided that will explain how to enroll in the portal. Patients can also go directly to the portal by clicking HERE.

BILLING

Does my insurance plan cover the service I’m having?

Before having the service, please contact your insurance company to confirm coverage under your plan and that St. Clair is a participating provider. St. Clair participates in most major insurances and benefit plans. To review the insurance plans that St. Clair Hospital participates in, click HERE. After you have the services, your insurance company will review your claim to determine if your benefit plan covers the service. Any service not covered under your plan will be billed to you. You may receive a bill for any of the following reasons:

  • You are self insured, or we do not have your insurance information on file to bill
  • Under your insurance plan you have a copay, coinsurance or deductible to fulfill
  • The service you received may not be covered under your insurance plan
  • Your insurance coverage is out-of-network or does not participate with St. Clair Hospital
  • You have reached your out of pocket limit for your insurance plan
  • Your insurance may have denied your claim stating another insurance is primary over the Insurance we have.  Please contact the office with any additional primary insurance you may have.  If you have no other insurance, please contact your insurance carrier to update your file and reprocess your claim, and then notify us of the correction.

Can you help me understand my billing statement?

Your St. Clair Hospital billing statement provides you with a summary of charges, insurance and patient payments and adjustments as well as current hospital balance for a specific date of service. Click HERE for an example of a billing statement. Your billing statement will provide you with any account activity since your prior billing statement for that specific date of service, including adjustments or payments made in the previous 30 days. Adjustments shown on your billing or itemized statement include contractual adjustments made on the basis of contracts which St. Clair Hospital has with your insurer or discount adjustments given for making your payment on the date of your service.

If you need a more detailed breakdown of charges from your visit to St. Clair Hospital, you can also request an Itemized Statement by calling 412.344.3408 or emailing pfs.analyst@stclair.org. An itemized statement will provide you with more detailed charge information as compared to your monthly billing statement, which will provide you with general service categories in summarizing account charges.

Why do I keep receiving bills?

Each visit to St. Clair Hospital will have a separate account number and will be billed to your insurance company separately. Check to see if the date of the service provided and the account number are the same or different. Additionally, we could have received and processed your payment after your next statement was mailed. If you need assistance with a specific bill please contact 412.344.3408.

How can I pay my bill?

If you would like to make your payment online by either checking account or credit/debit card, you can visit our Webpay site by clicking HERE. You can also submit payment in the following ways:

  • Calling our customer service department at 412.344.3408
  • Visiting our cashier’s office, located on the 4th Floor of the Hospital by the Bower Hill entrance. The office is open from 8:00-4:30 Monday-Friday.
  • Mailing in your payment to:

    PO Box 640831
    Pittsburgh, PA 15264

Why didn’t my insurance pay my bill/why am I receiving a bill?

You may be receiving a statement for several different reasons, including:

  • You are self insured, or we do not have your insurance information on file to bill
  • Your insurance informed the hospital that you were not covered for the date of service
  • Under your insurance plan you have a copay, coinsurance or deductible to fulfill
  • The service you received may not be covered under your insurance plan
  • Your insurance coverage is out-of-network or does not participate with St. Clair Hospital
  • You have reached your out of pocket limit for your insurance plan

You can contact your insurance company to ensure that they received and processed your claim, or for an explanation as to how they processed your claim.

My insurance has changed, how do I update it?

Please bring an up to date insurance card with you to each visit so that we can ensure the timely processing of your claims. If your insurance has changed since a prior visit, please give our customer service department a call at 412.344.3408 so that we can update the information. Having an incorrect insurance on file can delay processing of claims and billing, and can result in denials of services.

Why does my billing statement show that I was in observation and not admitted as an inpatient?

Observation is a special outpatient service or status that allows physicians to place a patient within the hospital, for a limited amount of time while it is determined if the patient should be admitted or discharged. Observation patients may occupy a bed anywhere in the hospital. The quality of care is exactly the same whether you are an observation patient or inpatient admission. During the observation stay, your physician and care manager will work with your insurance company to complete your status as to whether you require an inpatient stay or observation care. Your insurance company determines the amount of time that is covered under observation. For example:

  • Medicare observation services frequently do not exceed 48 hours. Typically a decision to discharge or admit is made within 24 hours.
  • Private insurances may vary. The amount of time is based on the insurance company’s medical necessity criteria, which is defined as the severity of illness and intensity of service.

Outpatient observation stays often result in patients owing a copay as well as any other patient responsibility based on your insurance benefit level.

Can I set up a payment plan to pay my hospital bill if I cannot pay it in full?

You can set up a monthly payment plan by contacting our customer service department at 412.344.3408. If you want for your payments to be automatically withdrawn from your checking account or credit card, you can set that up online by visiting our Webpay portal HERE.

Do you offer Financial Assistance?

If you are having difficulty paying your bill you can apply for our Financial Assistance program. Click HERE to get an application. Financial assistance or free care is based on the size of your family and total annual estimated family income compared to the federal poverty level guidelines.  Once we receive your application and requested supporting documentation, we will review and make a determination within 15 days.  Financial assistance in the form of free care will be effective for six months from the date determination is made for medically necessary care.

What is the difference between my account number and my medical record number?

Your account number is specific and unique to each individual visit that you have at St. Clair Hospital. Your medical record number is unique to you as a patient and is the same for each visit that you have.

Key Terms and Definitions

Insurance Allowable/Contracted Amount: The estimated rate your insurance company has agreed to pay for each service provided.

Co-Pay: The set amount which your insurance company expects you to pay upon each visit for a specified service.

Deductible: The set amount you have to pay each year before your insurance plan starts paying benefits.

Co-Insurance: A certain percentage of the allowed amount covered that your insurance requires you to pay and which is paid after you reach your deductible on covered services.

Your Estimated Cost: The estimated amount you will be responsible for paying.

Guarantor: The individual who is responsible for paying a patient’s account

Covered Charge: A charge that your health insurance company will pay for

Medically Necessary: Services, prescription drugs and supplies that are needed to treat a medical condition

Non-covered Charges: Charges that are not paid or are excluded by your insurance company.

Charge: The dollar amount set for each service rendered, prior to any insurance contract or self pay discounts being taken