Patient Representatives and Financial Eligibility Specialists are available to help decide the best way to pay for services. This can be done before your first visit to the clinic. You may contact your Patient Representative any time you have questions regarding your bill, benefits, or your insurance plan. Please call a Patient Representative for assistance, at 719-589-5161 or 888-323-2706. Patients may request information about service charges. Charge-estimates may be provided based on usual and customary care, but actual charges may vary due to each individual’s unique circumstances.
Valley-Wide will bill your insurance company when you give us the following information:
- complete name and address of insurance company,
- subscriber number
- group number
- name of policy holder
- policy holder’s signature to assign payment to Valley-Wide and release information to the insurance company.
Valley-Wide collects this information at the time of your visit. Valley-Wide will bill your insurance company for the appointment within 30 days. You are expected to pay any deductible, copayment or coinsurance amounts at the time of receiving services. You are responsible for any part of your bill not covered by your insurance.
However, you may choose to pay in full at the time of services, then bill your insurance company for payment. When you pay for services you will receive a copy of the encounter form. Payment from your insurance can then be mailed directly to you after you submit the yellow copy along with a claim form to your insurance company, or after you submit documentation as required by your insurance company.
Patients who do not have insurance or other medical benefits should pay for their services when they receive them. If a patient has trouble paying in full at the time of visit, he or she can meet with the Patient Representative for help in setting up payments. Low-income patients may qualify for public assistance programs. Valley-Wide’s eligibility technicians and case management staff can assist you with enrollment.
Medicaid (Including Colorado Access)
You must present your Medicaid card at each visit. The effective date needs to be verified each time by the receptionist or cashier. Medicaid requires that you, or any of your family members who are enrolled on Medicaid, need to formally make a choice about your Primary Care Provider that will be printed on your Medicaid card. If you would like to continue services in our health care system, we encourage you to select “Valley-Wide Health Systems, Inc.”
Valley-Wide offers application assistance for various Medicaid programs. . Please let the receptionist know you need assistance at the time of check-in for your appointment. Please note that Colorado Medicaid is changing its name to Health First Colorado in May of 2016
Child Health Plan Plus (CHP+)
Valley-Wide is a provider for the Child Health Plan Plus (CHP+). This health care program helps cover the cost of services for eligible Colorado children, youth, and pregnant women. Our staff can help you to determine if you or your child qualify for the plan and assist you with the application. The plan covers out-patient clinic visits, hospital services, glasses, prescriptions, mental health care and other needed services. For more information, contact one of our eligibility specialists or a case manager.
PPS & Medicare
If you are on Medicare, Valley-Wide will do all the billing for you. It is very important that you give us your Medicare number with the alpha letter. If you have supplemental insurance, we need the subscriber number, group number and name of policy-holder.
Question: What are the changes coming July 1, 2015 that may impact my Medicare Co-Insurance Payment?
Answer: A portion of the Affordable Care Act mandated that Medicare pay Community Health Centers, like VWHS, on a different methodology. This different methodology also effects how your co-insurance is calculated. Previously your co-insurance was calculated based on the charges for your visit and now your co-insurance will be based on the type of visit you have.
The different types of visits you may have are as follows:
- Medical Visit- Established Patient: This is a “sick visit” (non-preventative) with a Medicare patient who has been seen by VWHS before. Based on the new methodology the patient’s co-insurance will be $30
- Medical Visit- New Patient: This is a “sick visit” (non-preventative) with a Medicare patient who has NOT been seen by VWHS before. Based on the new methodology the patient’s co-insurance will be $38
- Initial Preventative Physical Exam or “Welcome to Medicare” visit: This is the first visit a Medicare patient has when they are newly eligible for Medicare. There are very specific requirements for this visit that must be met and this visit will have $0 co-insurance charge to the patient.
- Annual Wellness Visit: This is an annual preventative visit Medicare patients are eligible for once every 12 months and this visit will have $0 co-insurance charge to the patient.
Question: I am on a Medicare Advantage Plan, will my co-insurance change?
Answer: VWHS is only obligated to collect the co-insurance required by your Medicare Advantage Plan. Your Medicare Advantage Plan is aware of the changes stemming from this portion of the Affordable Care Act so changes may be coming from your Medicare Advantage Plan at a later date. Please contact them for more information.
Question: I have a secondary insurance; does this mean they won’t cover my co-insurance anymore?
Answer: No. We will still bill your co-insurance to your secondary insurance.
Sliding Fee Discount Program
The Sliding Fee Discount Program bases the amount you pay for Valley-Wide services you receive on your household size and income. This is to provide and facilitate access to health care services for patients who do not have the ability to fully pay for those services.
Who Can Apply?
Any eligible person seeking Medical, Dental, Physical Therapy, and/or Pharmacy services.
Who is Eligible?
Households with income of less than 200% of Federal Poverty Guidelines, considering all sources of income, before taxes, and household size.
Who is Not Eligible?
Households whose income exceeds poverty guidelines or who refuse to bring in required proof of household income.
THIS PROGRAM IS AVAILABLE TO EVERYONE REGARDLESS OF INSURANCE STATUS AND IS SOLELY BASED ON HOUSEHOLD SIZE AND INCOME.
How to Apply:
Schedule an appointment with a Valley-Wide Eligibility Specialist, or Case Manager at your nearest medical clinic. Be sure to bring required proof of income and household size.
Federal poverty levels change every year, so even if you did not qualify in the past, it is possible that you may qualify now.
Provide at least one item from the following list:
- Payroll Check Stub (One month’s worth of paycheck stubs showing gross income before taxes)
- Benefit Letter (Unemployment or Social Security Benefits Letter)
- Profit and Loss Statement (For Self Employed)
- Any Combination of the Above
The size of your household should include yourself, your spouse/partner, and children and any others being supported by your household income. An Eligibility Specialist or Case Manager will help you to determine who should be included. Name and birth date of each household member is required. You must include the income of all adult (over 18 years of age) members of the household – if an adult member of your household is not currently receiving any form of income, you will be asked to sign a formal statement as part of the application declaring zero income for the individual.
Federal Poverty Level Chart
The Department of Health and Human Services (HHS) updated the Federal Poverty Guidelines (FPG, also referred to Federal Poverty Level or FPL) for 2018 on January 13, 2018. The Federal Register posting about this update can be found here.
|Size of family