Common Questions about Billing

Depending on your visit, you may get separate bills from:

• CRMC for hospital or facility charges
• Individual providers for doctors, surgeons, or specialists
• Outside labs or imaging centers if services are outsourced

Hospitals often collaborate with specialists to provide the best care. These experts work alongside your primary provider to address specific health needs. The following facilities may bill separately for services performed at CRMC:

• Regional Diagnostic Imaging (RDR) – Imaging
• Minneapolis Heart Institute (MHI) – Cardiovascular
• Allina Health – Pathology & Lab Send-outs

A split bill occurs when your visit includes both preventive care and the evaluation or treatment of a medical condition. In such cases, charges are separated: the preventive portion is typically covered at 100% by most insurance plans, while services related to diagnosing or managing health issues may be applied to your deductible and coinsurance.

For example, a routine preventive exam or annual physical is intended to focus solely on maintaining your overall health. However, if you bring up new symptoms or need management of an existing condition—such as high blood pressure, diabetes, skin issues, or headaches—your provider may need to address those concerns separately during the same visit. When this happens, both preventive and medical services may be billed independently.

If your provider determines that the majority of your visit focused on medical issues, the entire visit may be billed as a medical (non-preventive) appointment.

Healthcare providers are required by federal law to follow billing and coding guidelines set by the Centers for Medicare & Medicaid Services (CMS). This ensures accurate and compliant billing for all services provided.

To learn more, read Understanding Split Billing: Preventive vs. Medical Visits

These are medications you could take on your own (like aspirin or insulin), even if they’re given to you at the hospital. Some insurers do not cover these and you may be billed separately.

To learn more, read Medicare Coverage for Hospital Outpatient Drugs

Deductible
The amount you pay each year before your insurance starts covering services.

Copay
A fixed amount you pay for certain visits or medications, like $25 for a primary care appointment.

Coinsurance
A percentage you pay for services after you’ve met your deductible (e.g., you pay 20%, insurance pays 80%).

Out-of-pocket maximum
The most you’ll have to pay in a year. After you hit this limit, insurance covers 100% of covered services.

In-network vs. Out-of-network
In-network providers have agreed rates with your insurer. Out-of-network care typically costs more.

Coordination of Benefits (COB) is how insurance companies decide who pays first when you have more than one insurance plan. The primary insurer pays most of the cost, and the secondary may cover the rest. This process ensures each company pays the correct amount before claims are processed. Patients will receive a COB letter in the mail, it is their responsibility to fill out the form and call their insurance company. It is not CRMC’s responsibility.

Most insurance plans cover preventive visits at no cost. However, if your provider addresses health issues or orders tests during the visit, it may become a diagnostic appointment and cost more. Medicare covers annual wellness visits, but never covers annual physical exams.

CRMC is part of an Accountable Care Organization (ACO) – a group of healthcare providers working together to give you coordinated, high-quality care.

With an ACO, your doctors share information, so you get the right care at the right time—while avoiding duplicate tests, medical errors, and unnecessary costs. This means better communication, fewer frustrations, and a stronger focus on your health.

To choose a primary care provider, visit Medicare.gov and log in or create your secure Medicare account.

This type of exam is “prevention” focused, not problem focused. The exam may include:

• Health history and current medications

• Screenings (diabetes, cholesterol, cancer, depression)

• Age-appropriate checks (e.g., cancer, depression)

• Immunizations, if needed

• Personalized health advice and risk-reduction tips

Important Medicare Note:
Your provider may recommend services more frequently than Medicare covers or suggest services that aren’t covered. In such cases, you may be responsible for the cost. Ask questions to understand why these services are recommended and if Medicare will cover them. Learn more at www.cms.gov.

Your provider may not know your specific insurance coverage. Please review your Summary of Benefits or contact your insurance company before your preventive exam to confirm what’s covered.

When scheduling, say “routine preventive exam” or “annual physical” to ensure correct billing. Avoid using “checkup.” Let your provider know this is a preventive visit. Discussing chronic or new issues may lead to extra charges or require separate appointments. Medication management is not part of the physical and providers will not refill prescriptions. Patients will instead be scheduled for a medication management appointment.

As of October 2024, the Minnesota Debt Fairness Act protects spouses from being held responsible for each other’s medical debt—both while living and after death.

This means:

• You are not required to pay for medical bills in your spouse’s name.

By law (HIPAA), we can only share billing or account information with the patient or the person listed as the account guarantor. This helps protect your privacy and personal health information.

A person becomes an account guarantor when they take financial responsibility for a patient’s medical bills. This usually happens during the registration or check-in process.

A guarantor is typically:

• The patient, if they are an adult and responsible for their own bills
• A parent or legal guardian for a minor
• A spouse or caregiver who agrees to take financial responsibility
• Another party legally responsible, such as through a court order