Financial Information

Understanding hospital bills and health insurance claims can be confusing. Therefore, our Patient Financial Services professionals are here to serve you and are prepared to answer your questions Monday – Friday from 8:30 a.m. to 5:00 p.m. in our billing office located in the Broadway Plaza Complex, 203 S. Vine, Suite 5, Sparta, IL 62286.  You may also reach us at 618-443-1338 during those times. For clinic information or questions please call 618-443-6821.  Thank you for choosing Sparta Community Hospital District – we are proud to have you as a patient at our facility.

We participate in most major insurance plans. The list of accepted plans below is a reference tool, subject to change, meant to identify which plans we may currently be participating in as an In-Network provider. We recommend that you or a family member confirm that both your physician and the hospital are listed as participating providers with your plan. For information regarding how services and procedures will be covered, whether a service or procedure requires pre-authorization or any other questions regarding coverage or eligibility, you should contact your health plan directly by calling the number listed on the back of your health insurance Member Identification cards.

Sparta Community Hospital District does provide Financial Assistance, (in full or in part) for some services depending on income and asset levels and patient residence. To apply for Financial Assistance, please follow this link to our Application for Financial Assistance including a description of the Financial Assistance application process and a copy of the Financial Assistance application.

Note – False or incomplete applications for Financial Assistance (Charity Care) may be denied.

Sparta Community Hospital (SCH) believes you should have access to the information you need to make informed healthcare decisions.  Therefore, SCH has adopted a policy that allows the public to view its standard charges for healthcare services. The policy is intended to promote transparency for patients to understand their potential financial liability for service obtained at SCH and to allow comparison for similar services across hospitals.

Typically, hospital charge masters are lengthy and complex documents and do not provide information at a level conducive for this purpose.  Therefore, patients may contact our Patient Financial Services staff at 618-443-1338 (hospital) or 618-443-6821 (clinics) to request a specific charge estimate and discuss their financial obligations based on their specific circumstance.  Another option is to access The Patient Liability Estimator Tool below to obtain an out-of-pocket cost estimate for selected services and/or items, providing additional information regarding average procedure charges and other details.

Charge estimates are calculated based on care without complications. Actual charges may be different for specific patients due to medical condition, length of time spent in surgery or recovery, necessary specific equipment, supplies or medication, complications requiring unanticipated procedures, or other treatment ordered by the physician. Charge information does not include the professional services provided by a physician, surgeon, radiologist, anesthesiologist, pathologist, or any other independent practitioners.

Access the Patient Liability Estimator >>

Hospital charges are the amounts set before any discounts, and hospitals are required by the federal government to utilize uniform charges as the starting point for all bills.

If a patient has health insurance, significant discounts have already been obtained by the insurance company and the patient only needs to pay the deductible, copay and/or coinsurance. Patients should contact their health plan directly for their specific financial obligations that aren’t reimbursed by insurance.

If a patient does not have health insurance, significant discounts are available that could result in either the care being free or at a greatly reduced price. Contact our Patient Financial Services staff at 618-443-1338 (hospital) or 618-443-6821 (clinics) for more information.

View our price listing >>

CMS-HPT.TXT

Effective January 1, 2022, the No Surprises Act was established to protect patients who receive health insurance coverage through their employer (including a federal, state, or local government,) through the Health Insurance Marketplace®, or directly through an individual health plan from being balanced billed for services when they are treated by a non-contracted provider or facility in the scenarios defined below:

• Prohibit surprise billing for emergency services. Emergency services, even if they’re provided out-of-network, must be covered at an in-network rate without requiring prior authorization.
• Prohibit balance billing and out-of-network cost-sharing (like out-of-network co-insurance or copayments) for emergency and certain non-emergency services. In these situations, the patient’s cost for the service cannot be higher than if these services were provided by an in-network provider, and any coinsurance or deductible must be based on in-network provider rates.
• Prohibits out-of-network charges and balance billing for ancillary care by out-of-network physicians at an in-network facility.
• Prohibits certain other out-of-network charges and balance billing without advance notice.
• Before health care providers and facilities can bill the patient, they must provide the patient with a plain-language notice explaining that patient consent is required to get care on an out-of-network basis, ask for consent, and provide a good faith estimate in the allotted timeframe.
• For patients who do not have insurance (uninsured or self-pay), these rules make sure the patient knows how much their health care will cost before they get it, and might help them if they get a bill that is larger than expected by allowing them to file a dispute when the actual cost is greater than $400.00 from the estimate.
• The rules do not apply to patients with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE because these programs have other protections which do not allow balance billing.

 To read the No Surprises Act disclosure in its entirety, please click here.

Required Health Plan Pricing Link

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

 Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call our Patient Financial Services staff at 618-443-1338.

To read the Good Faith Estimate disclosure in its entirety, please click here.