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Billing and Insurance

Answers to your billing and insurance questions

Billing FAQs

  1. Am I responsible for my bill?
  2. Can I receive an itemized bill?
  3. What services are reflected on the statement I receive? 
  4. Are physicians' fees included in my hospital bill?
  5. Do I need to pre-register for my appointment?
  6. Do I need to pre-register if I'm pregnant?
  7. How do I submit a claim to my insurance company?
  8. Do you accept Medicare?
  9. What do I do if I am unable to pay my hospital bill?
  10. Do you offer payment plans?
  11. Do you accept credit cards?
  12. Can I pay my hospital bill online?
  13. What is my co-pay for outpatient services provided at the hospital?
  14. How can I request an online bill pay refund?
  15. Why does my statement come from Toledo, Ohio?
  16. Why are my payments mailed to a P.O. Box in Milwaukee?

Insurance FAQs

  1. What if my insurance doesn’t cover the entire cost of my care?
  2. What insurances do you accept?
  3. Do I need pre-certification for hospital services?

Am I responsible for my bill? Yes. Your account is your responsibility and you are responsible for payment of any services provided. As with any bill, we expect to receive payment in a timely manner.

We will first bill Medicare, Medicaid or your insurance for services provided. Any portion of your bill that is not covered by insurance is your responsibility.

You will be required to sign a General Consent for Treatment/Admission which includes an agreement to pay regardless of third-party insurance coverage.

Please note that delinquent accounts are referred to outside collection agencies when payment in full has not been received, financial assistance approved or appropriate payment plans have not been arranged. These accounts are assessed interest.

Can I receive an itemized bill? Yes. We do not routinely send out copies of itemized patient bills. However, if you would like a copy of your itemized bill, please call the Central Business Office at 1-866-432-7855.

What services are reflected on the statement I receive? Your statement will reflect billings for ProHealth Care Medical Associates physicians, as well as any services received from a ProHealth Care Hospital or Outpatient center. Your statement will reflect balances due after they have been processed by any insurances that are listed on your account. 

Are physicians’ fees included on my statement? Your statement will reflect balances due for any ProHealth Care Medical Associates physician involved in your care.  It will not include charges for physicians who may have seen you in a hospital setting that are not part of ProHealth Care Medical Associates. These physicians will bill separately for their services. These physicians include pathologists, radiologists, emergency room physicians and anesthesiologists.  Questions about physicians’ fees should be directed to their billing offices. Although it is rare, on occasion you may be treated by a physician who is not considered in-network with your health insurance plan. Should this occur and result in problems with payment, we encourage you to contact your insurance company to determine if your plan contains a special provision for instances when there was not a choice of which physicians became involved in your care. If you have any questions, please contact our Central Business Office at 1-866-432-7855.

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Do I need to pre-register for my appointment? Yes. To avoid delays in treatment for scheduled hospital appointments, we request that you pre-register so that we may obtain all necessary information to provide your care. This includes insurance information, personal data, emergency contacts, religious preferences and more. 

For your convenience, you may preregister for your hospital services by contacting Waukesha Memorial Hospital’s Admitting office at 262-928-4045 or Oconomowoc Memorial Hospital’s Admitting office at 262-569-0257. You may also preregister for your appointment with a ProHealth Care Medical Associate physician by calling 262-928-2500. 

Do I need to pre-register if I’m pregnant? Yes. If you are expecting a baby and plan to deliver at either Waukesha Memorial or Oconomowoc Memorial Hospital, pre-registration is requested. Pre-registration forms are available in your physician’s office.

If your insurance changes during your pregnancy or course of treatment, it’s very important that you provide this information to your caregivers and our Central Business Office as soon as possible. Changes to your insurance may affect your benefits and new authorizations for treatment may be required.

How do I submit a claim to my insurance company? If you have insurance or HMO/PPO coverage, our Central Business Office will bill your insurance on your behalf if complete billing information was provided at the time of service. You will receive a statement from us if your insurance carrier or HMO/PPO does not pay the bill promptly or if there is a balance remaining after the insurance or HMO/PPO payment.

If you have questions regarding your insurance company’s payment, you should contact your insurance company directly to check on the status of your claim.

Do you accept Medicare? Yes. Waukesha Memorial Hospital, Oconomowoc Memorial Hospital and ProHealth Care Medical Associates are participating providers for Medicare and accept assignment of covered benefits. After Medicare pays its portion of the charges, we will bill your supplemental insurance based on the information you provided during the registration process. You will receive a statement from us notifying you of your responsibility if there are any balances remaining after Medicare and your supplemental insurance payments.

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What do I do if I am unable to pay my hospital bill? Patients who are unable to pay for services are welcome to apply for ProHealth Care’s Financial Assistance Program. Applications are available by calling our Central Business Office at 1-866-432-7855. Applications are also available in the admitting departments at Waukesha Memorial Hospital and Oconomowoc Memorial Hospital, as well as in our ProHealth Care Medical Associates clinics. Eligibility is based on residency, household income, family size and the financial resources of your household.

To be eligible for assistance, you must be a legal resident of ProHealth Care’s primary service area. Federal poverty income guidelines are used as the basis for eligibility.  Our financial assistance policy is available on this website by clicking on the following link: Financial Assistance Policy >

ProHealth Care also offers payment plans. If you would like to arrange a payment plan, please contact our Central Business Office at 1-866-432-7855.

Please note that delinquent accounts are referred to outside collection agencies when payment in full has not been received or appropriate payment plans have not been arranged. These accounts are assessed interest.

Do you offer payment plans? Yes. To arrange a payment plan or obtain more information, please contact our Central Business Office at 1-866-432-7855.

Do you accept credit cards? Yes. ProHealth Care accepts MasterCard, Visa, American Express and Discover. Please call 1-866-432-7855 to make a payment. You may also pay your ProHealth Care bill online .

Can I pay my bill online? Yes. ProHealth Care offers online bill payment. It is helpful if you have your ProHealth Care statement available when making your on-line bill payment. Online payments are secure. Visit our online bill payment page to make a payment.

What is my co-pay for outpatient services provided at the hospital? If you are being seen in an outpatient department of the Waukesha Memorial or Oconomowoc Memorial Hospital, please be aware that this is not a doctor’s office. This visit will be billed as a hospital outpatient service and your hospital benefit levels will apply. You might receive more than one bill after your care.

  • One bill will be for hospital charges

  • You might also receive a bill for the professional services of any doctors you see today or any doctors who interpret results of your diagnostic tests.

If you are a Medicare patient, listed below is an estimate of your coinsurance amount only. Your actual out-of-pocket expense may be higher or lower depending on your deductible, and any other insurance that you may have.  

Angiography ($175 – $355)

   

Biopsy ($32 – $300)

CT Scans ($40 – $150)

   

Carpal tunnel ($240 – $260)

Diagnostic Radiology ($30 – $110)

   

Cataract Procedures  ($110 – $510)

Mammograms ($6 – $16)

   

Chemotherapy ($5 – $40) drugs not included

MRI ($140 – $205)

   

Colonoscopy Procedures ($200 – $320)

Myelography ($130)

   

Debridement ($10 – $20)

Myocardial Scans ($150)

   

Endoscopy ($145 – $240)

Nuclear Medicine ($45 – $120)

   

ENT Procedures ($37 – $623)

Ultrasound ($25 – $70)

   

Eye Procedures ($46 – $812)

Venogram ($115)

   

Foot Procedures ($355 – $500)

     

GI procedures ($150 – $250)

Echocardiogram ($100 – $110)

   

Hemorrhoid Surgery ($225 – $245)

EMG ($15 – $20.00)

   

Injections ($5 – $30)

Stress Tests ($210.00)

   

Kidney Stone ($1025 – $1225)

Vascular Studies ($20 – $35)

   

Nail Procedures ($10 – $80)

     

Nerve Injections ($44 – $375)

Cystoscopy ($78 – $85)

   

Sigmoidoscopy ($70 – $90)

Interstim Programming ($20 – $70)

   

Trigger Finger-tendon sheath ($270 – $420)

Percutaneous Tibial Nerve Stim ($41 – $50)

   

Wound Care ($31 – $75)

Urodynamic Study ($75 – $150)

     
     

Cardiac Rehab ($15.00 – $25.00)

Clinic Visits ($9 – $20)

   

Physical Therapy ($5.00 – $15.00)

If you are a non-Medicare patient, we may ask you to pay the co-payment amount indicated on your insurance card. This amount will be applied toward the balance due from you (if applicable) after your insurance pays. Additional amounts you will owe, which could include a deductible, co-insurance and non-covered services, will depend upon your insurance plan. 

If you have any questions about your bill or your explanation of benefits, please call our Central Business Office at 1-866-432-7855.

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Online Bill Pay Refund Policy

All transactions processed through ProHealth Care’s Online Bill Payment system are eligible for a refund. To cancel an online payment that has already been submitted, please contact ProHealth Care’s Central Business Office at 1-866-432-7855.

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Why does my statement have a Toledo, Ohio return address? As is common with many healthcare systems, we use a vendor to print and mail our patient statements.  This vendor also handles any returned mail that is received.  The office of our statement vendor is located in Toledo, Ohio.

Why are my payments mailed to a P.O. Box in Milwaukee? All patient payments are sent to a P.O. Box in Milwaukee, where they are then routed directly to our bank for deposit. These payments are reflected on your statement as “lockbox payments.”  The payments received at the bank are sent to us in an electronic file that gets applied to your account.

Insurance FAQs

What if my insurance doesn't cover the entire cost of my care? If any portion of your account is not covered by insurance, you are required to pay the balance. Please contact our Central Business Office at 1-866-432-7855, Monday through Friday, 8 a.m. to 5 p.m., for more information or to make financial arrangements.

Please note that delinquent accounts are referred to outside collection agencies when payment in full has not been received or appropriate payment plans have not been arranged. These accounts are assessed interest.

What insurances do you accept? ProHealth Care participates in most managed care plans offered in the Waukesha/Milwaukee area. If you have a question about whether or not we participate in your insurance plan, please check directly with your insurance carrier.

Do I need pre-certification for hospital services? Most insurance plans require you to obtain pre-certification; however, it is up to you to find out if your insurance or HMO/PPO requires pre-certification for any care provided. If pre-certification is required and you or your physician do not take steps to ensure that this authorization is obtained, reduced benefits or the denial of your entire claim by your insurance company is possible.

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