Billing & Insurance Information

No Mountainside Medical Center patient is denied care based on a third-party determination. In conjunction with your physician, our case manager, social worker and financial counselor will work closely with you and your family. They will help identify an alternate care setting, payment arrangements, help from charitable agencies and organizations, or in some cases, reductions in your bill.

About your bill

Most insurance carriers take 30 to 45 days to process a claim, after which the hospital will seek your assistance in getting paid. If a claim is not paid within 75 days, the hospital will consider the bill a patient’s responsibility.

You should verify the accuracy of any bill when you receive it, and compare statements from the hospital and insurance carrier to ensure that they are in agreement. Also, follow up with the insurance carrier or hospital if you have not received a bill or notice of payment within 45 days of service. Insurance carriers frequently deny claim submissions after 60 days, and payment for late submissions may be considered your responsibility. You should assist the hospital in appealing to the insurance carrier for any services that are not paid. Your prompt payment of deductibles or coinsurance is appreciated.

Insurance Information

OUT OF NETWORK

Hackensack Meridian Health Mountainside Medical Center is committed to providing information our patients need to protect them from receiving a surprise medical bill.

We have worked throughout Mountainside Medical Center to try to make sure we are meeting the requirements of New Jersey’s new law.

While we have taken steps to fully comply with our requirements on behalf of patients, it is very important that healthcare consumers also consult their own health insurance plan. Only your health insurance plan can provide detailed information about your coverage and potential obligations for certain out-of-pocket costs. The contact information is on your insurance card.

In accordance with the new law, we have listed below the insurance plans whose networks we participate in. You can contact the physician directly to ask about their network status with your particular health insurance plan.

  • Aetna (All products including Medicare Advantage)
  • Aetna Better Health (Medical plan)
  • Americhoice (Medicaid plan)
  • Amerigroup (Medicaid plan and Medicare Plan)
  • AmeriHealth (All products)
  • CHN
  • CIGNA
  • Clover Health/Carepoint
  • Devon Health Services
  • Empire Health Plan
  • First Managed Care Option
  • Horizon BCBS of New Jersey (All products, including Omnia Tier 1)
  • Horizon NJ Health
  • Brighton Health Plan Solutions fka MagnaCare (Create Flex and Select Products)
  • PHCS/Multiplan
  • Qualcare
  • TRICARE/Champus - Humana Military
  • UnitedHealthcare/ Oxford Health Plan
  • United Payers and United Providers
  • UMR
  • Wellcare Medicare

EXCHANGE PLANS

  • AmeriHealth (AmeriHealth Advantage Plan)
  • OMNIA (Horizon)
  • Oscar

*Please note: this list is subject to change. This list should not replace the confirmation of a patient’s eligibility and coverage with a specific health plan.

While we have tried to make our network status clear to all healthcare consumers, it is important to note that the state’s new out-of-network law does not apply to health insurance plans issued outside of New Jersey. Even if you live in New Jersey, if your employer is located in another state, it is possible that your plan is not covered by the law. Also, the new law is optional for self-funded plans. Self-funded plans are when the employer assumes the responsibility to cover all of the expenses of the plan. Self-funded plans are only required to follow federal requirements, not state laws. A self-funded plan may opt in and elect to be subject to New Jersey’s out-of-network law, but it is not required to do so. It is important that you ask your employer or health insurance carrier whether the new law applies to your plan.

All stakeholders – insurance plans, healthcare providers, state policymakers and regulators – must try to make this complex law understandable to healthcare consumers, particularly those who may not realize that their plan is not covered by these new protections.

If you have any additional questions please do not hesitate to contact (973) 873-7787.

For Further Information:

Financial Assistance

What if I don’t have insurance and I don’t qualify for financial assistance?

Mountainside Medical Center offers reduced rates to patients without insurance who don’t qualify for financial assistance. These rates are based on those paid by Medicare. Please contact the Billing Department at 1-866-525-5558 for further information.

What is financial assistance?

The State of New Jersey defines financial assistance as Charity Care or Uncompensated care for patients who have income and asset limits that fall within the set guidelines.

What services are eligible for financial assistance?

All inpatient and outpatient services provided by Mountainside Medical Center that are defined as medically necessary by the State Department of Health. Physician charges are not eligible for financial assistance.

Who can apply for financial assistance?

The state has defined that all patients who are residents of the State of New Jersey are eligible to be screened to receive financial assistance. You may apply for yourself or as a guardian to a patient. Applicants with assets that can readily be converted to cash of over $7,500 per individual or $15,000 per family will not be eligible for assistance.

Is it possible to set up a payment plan?

Mountainside Medical Center will work with patients who request payment plans. The payment plan may not exceed six months and the patient must pay a minimum of $25 per month.

What if I can’t make my payments?

When a patient is delinquent in his or her payments, a notice will be sent to the patient offering to discuss the bill and determine if financial assistance or a new or revised payment plan is needed. Patients who fall behind in their payments and do not arrange with the Financial Counseling Office or the Customer Service Office for an alternate payment plan will have their accounts turned over to a collection agency. This will occur when no payment has been received for 120 days or more.

How do I apply for assistance?

You may apply by calling the Billing Department at 1-866-525-5558.

What time may I call for an appointment?

You may call from 9:00 a.m. to 5:00 p.m., Monday through Friday.

When can I apply?

We encourage all applicants to apply as near to the time of service as possible. All patients must apply for financial assistance at the time of service if emergent and prior to service if non-emergent. An appointment can be made 2 weeks in advance of the scheduled services.

What services are not covered?

Some of the services not covered are: physician fees, elective cosmetic surgery, telephone, television, patient convenience services, labor and delivery charges and certain other services. If you have any questions, call the Billing Department at 1-866-525-5558.

Do I need to bring anything with me when I apply?

You will be asked to show proof of income and residence. In addition, You will be asked to bring as many of the following that apply to your situation:

  1. Identification: Acceptable forms of identification for a patient and each dependent (spouse, minor children, and full-time students up to 23 years old) include:
    • Valid driver’s license
    • Social security card
    • Birth certificate
    • Valid passport/resident alien card (green card)
    • Employee ID card
  2. Proof of residency one month prior to service date. Acceptable forms of New Jersey residency include:
    • Driver’s license issued at least 1 month prior to service date
    • Utility bills
    • Identification card with address
    • Apartment lease/house deed
    • Letter from person providing shelter
  3. Health Insurance Verification: Copy of your and your spouse’s health insurance ID Card(s). The New Jersey Hospital Care Program is based on need. The following information is required to determine eligibility. All information is kept strictly confidential.
  4. Income and assets: Documentation for all members immediately prior to service date.
    Proof of income includes:
    • Pay stub
    • Social security/SSI/pension award letters
    • Welfare/disability/unemployment stubs

    Proof of assets includes:
    • Checking/savings account statements
    • Stocks and bonds
    • Real estate equity (not primary residence)

Is there any system in place for a patient to discuss and settle any potential problems that arise from this process?


Appeals or challenges must be put in writing and addressed to:
DIRECTOR OF SERVICES, Health Care for the Uninsured Program,
State of New Jersey Department of Health, Room 403,
CN 360 Trenton, NJ 08625-0360

 

Financial Assistance Policy

Plain Language Summary

English English
Chinese Chinese
Portuguese Portuguese
Spanish Spanish
French French
Haitian/Creole Haitian/Creole
Igbo Igbo
Italian Italian
Korean Korean
Russian Russian
Tagalog Tagalog

 

Financial Assistance Application

 

Departments not covered
by Financial Assistance Policy

English Department of Anesthesiology
Chinese Department of the Cancer Center
Portuguese Department of Emergency Medicine
Spanish Department of Hospitalists & Intensivists 
French Department of Pathology
Haitian/Creole Department of Psychiatry
Igbo Department of Radiology
Italian  
Korean  
Russian  
Tagalog  

Understanding Your Bill

Reducing the Confusion

You will probably receive more than one bill for services rendered by the hospital. Usually, one bill is sent for the use of hospital equipment, supplies, your room and board, and the time the nurses and other staff spend meeting your health care needs. The hospital bill does not include fees of any treating physicians.

You may receive separate bills from your personal physician, and any other physicians involved in interpreting tests or performing other services. For example, a cardiologist, pathologist, radiologist or anesthesiologist will each send a separate bill for his/her services. The physicians providing professional services in Anesthesia, Radiology, Pathology and the Emergency Department are not employees of Mountainside Medical Center. They are independent contractors. You will receive a separate bill from each of these independent contractor groups if these services are utilized during your hospitalization.

If you are covered by managed care, an HMO, or other insurance, the hospital will automatically bill the insurance company (or companies) on your behalf. This can only be accomplished if the hospital is provided with correct insurance information.

In most cases you are responsible for any charges not covered or approved by your medical insurance company or managed care organization. You must pay your bill promptly or notify the hospital if you cannot. In the case that you won’t be paying your own bill, you must tell us who will.

How charges are determined

Hospital charges are determined by Medicare or Medicaid – or are based on the hospital’s charges or negotiated rates with insurance companies. These parties do not pay for a hospital stay that is not medically necessary. Upon determination that hospitalization is no longer medically necessary, you and your physician will be notified as required by state regulation.

Calculating the cost of hospital care

If you request an itemized bill, the hospital will provide one – and will explain any questions you may have. You have a right to appeal any charges. We can also assist you in obtaining public assistance and the private health care benefits to which you may be entitled.

If you have Medicare