Billing and Insurance

 How are prices set?

Jefferson Healthcare sets prices comparable to other hospitals in the area and considers the resources needed to provide each service. Resources include staffing, time, equipment and materials used for service. Jefferson Healthcare reviews every line of the Chargemaster (list of charges with corresponding procedure codes) to ensure prices are comparable, match the complexity of the service and correspond to the resources needed to provide the service.

What is a Chargemaster?

The Chargemaster is the complete list of prices across all departments and service lines.  This list includes procedure codes for care and the price per unit.  Some units are obvious (per visit, per procedure), while others are based on diagnosis or a less straightforward unit (minute per surgery, duration of recovery).

Can this list of prices be used to get an estimate?

The list is a valuable tool for understanding prices, though most services involve a combination of prices.  Understand that in many cases, it is impossible to predict final charges because of variables that affect services.  Please contact our Financial Counseling office at 360-385-2200 ext 2271 for an estimate to ensure all components are considered.

How is patient financial responsibility calculated?

Patient responsibility varies by the payor and can include deductibles, copays, coinsurance, or other patient responsibilities.  Insurance companies determine the portion of the bill the member is responsible for, and the Jefferson Healthcare Financial Counselors team is available to help you understand these terms.

How do property taxes affect pricing?

As a public hospital with very low tax support compared to other public hospital districts, it is important to set prices sustainably to maintain very important services to our community.  Jefferson Healthcare does not go above the market median to achieve this priority.

Are prices different at different Jefferson Healthcare locations?

Jefferson Healthcare works to keep prices the same across different settings, although billing requirements result in variances in how these services are billed. Services are priced the same, though they may be broken into two components in specialty clinics.

Jefferson Healthcare is a partner to help patients understand the prices and potential patient responsibility.  Questions and/or concerns can be directed to the Financial Counseling team at 360-385-2200 ext 2271.

Can I get a discount?

Jefferson Healthcare offers an option for a prompt pay discount off total charges for uninsured patients. Jefferson Healthcare also offers a generous financial assistance program for those who qualify, regardless of insurance status.

You have the right to request an estimate of potential charges prior to receiving any medical service. Estimates may vary based on the complexity of your medical condition and any deviations from the initial care plan as determined by your provider. To request an estimate, please call 855.581.LINK (5465) for more information.

After your visit and your insurance company has reviewed your claim, a statement from Jefferson Healthcare will be mailed to you. Payment in full is due at this time. Please contact us to discuss your options if you cannot pay in full. You will receive three reminder statements and a final notice before being referred to a third-party agency if you have not paid. Prior to being referred to a third-party agency, a financial counselor will attempt to call you.

Washington state law protects you from ‘surprise billing’ or ‘balance billing’ if you receive emergency care or are treated at an in-network hospital or outpatient surgical facility.  Read more about this law: Balance Billing Protection Act.

Jefferson Healthcare contracts with other providers to help meet your care needs. These companies represent anesthesia, laboratory, radiology, sleep medicine, urology, etc. If you have questions about these companies, please contact the Financial Services Office.

We must make a reasonable effort to collect on accounts that are due. We do not harass patients for payment or use collection agencies that use pressure tactics. Any patient who states that he or she does not have the means to pay a bill will be referred for financial counseling to determine eligibility for one of the helping programs. We base our charging methodology on the American Medical Association’s standard procedural terminology codes to ensure consistency and fairness throughout our system. Our charges are in the mid-range for rural hospitals. We realize that hospital charges are increasing and the health care system is complex. Therefore, we have made a significant effort to ensure that access to needed care is available. If you have more questions, please call us at (360) 385-2271.

Jefferson Healthcare offers a variety of alternative payment options, including:

• Prompt pay discounts
• Interest-free payment plan arrangements
• Financial Assistance, which includes Charity Care and Sliding Fee Scale supported by Washington State Law

Jefferson Healthcare is committed to providing healthcare services to all people who are in need of medical attention, regardless of their ability to pay.  To learn more about applying for financial assistance, please visit our Charity Care Page.

Medicare’s Annual Enrollment Period is October 15 to December 7, 2024.  

It is important to choose a that considers Jefferson Healthcare in-network. Services provided outside a plan’s network may have a higher out-of-pocket cost.  Please note that Jefferson Healthcare accepts all forms of Medicare Supplement Insurance, also known as Medigap.

Get Support: State Health Insurance Benefits Advisors (SHIBA)
Olympic Area Agency on Aging runs our local State Health Insurance Benefits Advisors (SHIBA) program for Jefferson County. Call a SHIBA volunteer to get your Medicare questions answered at 1-800-562-6900 or (360) 417-8555. Or visit SHIBA online.

Additional Support: Jefferson Healthcare Financial Counselors
To learn about the Medicare insurance options available to you in 2025, you may also contact our Financial Services Office.

• Call us: (360) 385-2271, 9:00 am to 4:30 pm, Monday through Friday.

• Visit the Financial Services Office: 803 W. Park Ave. in Port Townsend.

What is Medicare Advantage?

Medicare Advantage is an insurance option that replaces traditional Medicare benefits with insurance plans administered by private companies under contract with the federal government.

Choosing the Right Plan
At first glance, Medicare Advantage plans appear to offer similar coverage to that provided by traditional Medicare in a simpler package. However, it is important to evaluate your own medical needs against plan coverage to determine which plan is right for you.

Pros and Cons
Refer to this comprehensive checklist to ensure you’ve considered budgets, provider locations, and what-ifs.

Regence Medicare Advantage will not be available in 2025.

If you have a Regence Medicare Advantage plan or have been notified that your current Medicare Advantage Plan will not be available in 2025, here are your options during the upcoming Medicare Annual Enrollment Period, which occurs between October 15 and December 7, 2024.  
  

Option One: Return to Original Medicare

Because you are involuntarily losing your Medicare Advantage plan, you will be automatically reinstated with Original Medicare starting on January 1, 2025. 

If you go back to Original Medicare, you won’t need medical approval for any Medicare Supplement (Medigap) plan you want. If you choose this option, you will not have to go through medical underwriting. (Medical underwriting is when insurance companies try to determine your health status by asking questions about your health history. They do this to decide if they should accept your insurance application, what price they should charge, and what limitations they should implement.)  

If you go back to Original Medicare, you may also decide to purchase a standalone Medicare Prescription Drug plan. 

Option Two: Shop for a Different Medicare Advantage Plan

You may choose a Medicare Advantage plan during the Medicare Annual Enrollment Period, which lasts from October 15 to December 7. Be sure to verify that your doctors and medications are covered by your Medicare Advantage plan of choice.

   

  

   

If you receive your Annual Notice of Change (ANOC) letter from your Medicare Advantage plan and you notice changes being made to your coverage for 2025, here are your options:

Option One: Return to Original Medicare. Contact your Medicare Advantage plan directly, and they will initiate the disenrollment process (or call 1-800-MEDICARE for assistance).

If you wish to purchase a Medicare Supplement plan (Medigap), you will likely need to pass the plan’s medical underwriting requirements.

You may also decide to purchase a standalone Medicare Prescription Drug plan.

Option Two: Shop for a different Medicare Advantage plan.

You may choose a Medicare Advantage plan during the Medicare Annual Enrollment Period, which lasts from October 15 till December 7. Be sure to verify that your doctors and medications are covered by your Medicare Advantage plan of choice.

Medicare Prescription Drug plans may experience noticeable changes for 2025. This may include plan premium increases or changes to the drugs covered by the plan. For a complete list of Medicare Prescription Drug plans available in your area, visit the plan finder tool on Medicare.gov. There, you’ll be able to compare and enroll in the Medicare Prescription plan of your choice.