CHN Affiliates - Clinics
Family Birth Center
Foundation & Volunteers
About Your Bill
Will I Be Billed?
After your insurance has completed processing your account and there is a balance due from you, you will be sent an itemized statement of our charges and all payments that have been made on your account.
How Do I Pay?
At the time of registration you will be asked to confirm your method of payment. The method of payment can be either personal payment or insurance payment, (which includes Medicare, Medical Assistance, private and group insurance and worker's compensation)
|You must present your Medical Assistance card upon registration.
This is a State regulation and if you do not show your card the charges
could become your personal obligation. There is a $3.00
co-payment for hospital services and a $1.00 co-payment physician office
visits. These charges are to be paid upon registration.
You will not be sent an itemized billing of your charges because Wisconsin State law prohibits us from doing so.
For additional information about Medical Assistance contact your representative or complete this form:
|The Medicare deductible, co-insurance, private room
differential and all non-covered services are your responsibility.
Medicare requires that physician fees be billed to WPS in Madison and
technical charges be billed to United Government Services in
Milwaukee. Please expect to receive an explanation of benefits
from each. If you have Medicare Supplemental insurance we will
gladly submit your claims for you. If you do not have supplemental
insurance, these charges are due from you.
For additional information about Medicare contact your representative or complete this form:
Community Health Network,
Wild Rose Hospital and Waushara Family Physicians Medicare Reps:
For Other Questions or Concerns:
contact Liz 920-361-5511 (or send email)
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