Billing & Insurance Frequently Asked Questions - English

On this page you can find answers to some common questions about billing and insurance procedures at Marshall Medical Center. If you cannot find what you’re looking for here, feel free to call our Business Office at 530-626-2618 or submit your question online.

Will my Insurance pay for my care at Marshall Medical Center?

The following questions may help guide you in better understanding your insurance and how it works. Some carriers and/or employers restrict the type of facility you can receive services at. Ensure that Marshall Medical Center will be covered without penalty or reduced/maximum payment:

• Is this care a covered service under my insurance policy?
  • Read your policy booklet or call the customer service number on your insurance card. It is important that when you receive a service, the facility, the physician, and the service are all part of your insurance benefits. Some carriers and/or employers restrict the type of facility you can receive services at. Ensure that Marshall Medical Center will be covered without penalty or reduced/max payment.
• Have I met my deductible?
  • Reductions in your deductible happen every time a claim is submitted. The most accurate way to know where you stand is by calling the customer service number on your insurance card. They can help you estimate what your financial responsibility will be for your medical services.
• Is pre-authorization required from my insurance company?
  • Every insurance company requires pre-authorization. Check your policy booklet or call the customer service number on your insurance card. If you think pre-authorization is needed, find out if your doctor has obtained authorization before you come to Marshall Medical Center. If pre-authorization is needed and your doctor does not get it, you may have to pay for the care.
• Is this an emergency?
  • If you come to our emergency room, you are entitled, by law, to receive an emergency medical screening exam, regardless of your insurance or your ability to pay. Your insurance must pay for the exam, as long as a prudent person would have believed an emergency existed.
• Is Marshall Medical Center a covered provider under my insurance?
  • Check your policy booklet or list of providers given to you by your insurance company OR call the customer service number on your insurance card to see if care is covered at Marshall Medical Center. See below for more information about the relationship between Marshall Medical Center and your insurance.
• Will Marshall Medical Center bill my insurance?
  • Yes. You may be asked to give us your insurance card or other information about your insurance. Even if Marshall Medical Center bills your insurance, you remain responsible for payment for all care you receive. This may include care denied or not covered by your insurance, as well as your deductible and copayment amounts.
• Is Marshall Medical Center contracted with my insurance?
  • We cannot answer this question because we do not have information about the plan you have chosen with your insurance company or if there are any special restrictions your employer may have imposed. Insurance companies sell many types of plans. Marshall Medical Center may be contracted with your insurance company, but not for all of the plans they offer. For example, services at Marshall Medical Center may be covered for someone with a PPO policy from Acme Insurance, but not for someone with an HMO policy from Acme Insurance. Employers question restricted services to a freestanding facility or place a maximum payment that could leave you with a higher out of pocket then if you had gone to where they wanted you to go.
  • Insurance plans may say that some services must be provided at places other than Marshall Medical Center, even if a contract with your insurance company is in place with Marshall Medical Center. Ultimately, understanding your insurance is your responsibility. Please call the customer service number on your card to avoid any financial penalties for not following your insurance plan guidelines.
  • In addition, certain insurance companies may use other networks of other insurance companies, and not tell Marshall Medical Center. Therefore, services at Marshall Medical Center may be covered through one of these networks, even though your insurance does not have a direct contract.
• Can I still get my care at Marshall Medical Center, even if my insurance may not cover the services?
  • We welcome the opportunity to provide you with excellent healthcare, regardless of your insurance. You should be aware that you may have to pay for the services you receive. However, you can choose to get your health care where you feel comfortable.
• What about physician services?
  • The care you receive at Marshall Medical Center includes Facility Services provided by Marshall Medical Center. Your care may require Professional Services provided by physicians. These physicians are separate from Marshall Medical Center and will bill you directly.
  • Verify that both Marshall Medical Center and the doctor are contracted with your insurance. It is possible that your insurance company is contracted with Marshall Medical Center, but not the physician providing your care and vice versa.
  • Some of the physician services provided within Marshall Medical Center include:
    • Diagnosing, evaluating and managing your health care needs, including emergency conditions
    • Ordering and reviewing your diagnostic tests
    • Reading and diagnosing your x-ray, CAT scan or MRI
    • Reviewing and diagnosing your laboratory and pathology samples
    • Supervising the administration of anesthesia
    • Performing surgical and specialized procedures
    • Some of the physician groups which provide care at Marshall Medical Center are the Marshall Center for Primary Care, Emergency Physicians Medical Group, El Dorado Anesthesia Group, Placerville Radiology Medical Group, and El Dorado Pathology Medical Group.