Patient Information

To enhance the time spent at CHI Health Good Samaritan by you and your guests, we are providing information from our Guest Information Guide. It is important to read this guide and keep it with you throughout your hospital stay.  Your care providers will add beneficial information to it along your healing journey.  If at any time you have questions, our staff is always available to help clarify procedures or listen to your comments.

Again, welcome to our hospital.  We value the trust you have placed in us to provide outstanding medical care. And remember, please let us know how we can make your experience the best possible. 

Getting Checked In

Coverage Pre-Certification

Many insurance plans have pre-authorization requirements. To avoid non-payment or reduction of payment, call your insurance carrier to clarify your benefits and requirements before your visit to the hospital.

Hospital Admissions

Upon arrival to CHI Health Good Samaritan, unless otherwise instructed, report to Admissions (located to your right after entering through either one of our main entrances: either the main entrance revolving door or the West Tower entrance.) A representative will ask for necessary information (Medicaid, Medicare, insurance card; driver’s license or other photo identification) to complete your medical record and make financial arrangements. In the absence of providing all necessary Medicare, Medicaid, insurance policy information AND verification of coverage, you will be responsible for payment of your account. Please be assured all information will be handled confidentially. Your room assignment will be determined by type of medical treatment and room availability.

During admission, you will be asked for your insurance card. If you fail to present your insurance information at this time, please contact our Patient Financial Services staff by calling (308) 236-9864 or 1 (866) 214-5888 at your earliest convenience. We can then update your account and/or provide alternative options to satisfy your financial obligation.

Receiving Financial Assistance­­

Patients with balances due resulting from limited or no coverage may qualify for financial assistance of up to a full discount of charges.

The hospital uses income guidelines issued by the Housing and Urban Development Department to determine a patient’s eligibility. Income, family size, available resources and the likelihood of future earnings are also considered. Our financial assistance program requires you to complete an application and provide proof of income. This program is available for medically necessary health care only. For an application, call (308) 865-7179 or (308) 865-7230 or visit our on-site medical eligibility counselors in Admissions. Medical eligibility counselors are available to assist patients in applying for public benefits such as Medicaid, General Assistance, Social Security Benefits, and Crime Victim’s Compensation through state and federal agencies at no cost to patients.

Billing

CHI Health Good Samaritan is dedicated to fulfilling our mission of providing the highest quality care. To ensure the success of this commitment, we must be financially responsible.

Our goal is to simplify the confusing world of health care billing and help you understand our billing services.

Your Bill from the Hospital

• Depending on your coverage, we request payment of the patient portion of your charges at the time of service. If you do not have coverage, you may be asked to pay a portion of your total estimated charges up front. If you lack the financial resources at the time of service, we will still provide all medically necessary treatments. The hospital offers medical eligibility counselors to assist you with eligibility for financial assistance programs. To reach them, please (308) 865-7179 or (308) 865-7230. To request an itemized billing statement or assistance with payment arrangements, please call 1 (866) 956-3775 or 1 (866) 658-7852. We accept personal checks, cash, credit card, debit card, or money orders.

Your Bill from Your Physician

• Most physicians (radiologists, anesthesiologists, pathologists, cardiologists, etc.) are not employed by the hospital. Instead, they have privileges to admit patients to the hospital. In addition to your hospital bill, you may also receive a bill from these specialists. Insurance laws prevent us from adding their charges to your bill. All questions about physicians’ bills should be referred to those individual physicians’ offices.

Billing Your Coverage Provider(s)

• Private Insurance: The hospital will bill your insurance carrier shortly after your visit. After insurance has paid their portion, you should receive final payment information, which could include statements, letters and phone calls.
• Workers Compensation: When your health care service is the result of a work-related injury and your employer/carrier accepts responsibility, we will bill your employer/carrier. If we do not receive timely payment, we may ask you to contact your employer/carrier. If your employer/carrier denies your claim, we will bill you directly.
• Third Party Liability: If you have been injured in some manner (automobile accident, fall, etc.) another party may have some legal responsibility for your injuries. Although this matter is between you, your attorney and the party responsible, we will bill the liability insurance on your behalf. If you are a Medicare or Medicaid beneficiary, health care laws require that we bill the liability insurance first, then Medicare or Medicaid. In the event that the liability insurance denies your claim, we will bill you or your coverage provider. Please note if you are insured with Blue Cross Blue Shield, we are required to bill them first, even if the services provided are the result of an accident or illness caused by a third party.
• Medicaid: We will bill Medicaid when all necessary information has been provided, including your “Share of Cost” form, if needed.
• Medicare: We will bill Medicare and your supplemental or private insurance plans on your behalf. You are always responsible for any applicable deductibles, co-payments or other amounts not paid by Medicare. Please see your “Medicare & You” handbook for more details regarding non-covered items and services. For questions regarding Medicare coverage and benefits, please call 1 (800) MEDICARE or visit www.medicare.gov.