Business Services

About Your Bill

How 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)

Personal Payments

If your insurance requires a co-pay for emergency room or physician office visits, payment is expected at the time of service. Your payment can be made at your doctor's office or at the CHN Business Services Office located at Berlin Memorial Hospital during regular office hours Monday through Friday from 7:30 a.m. until 5:00 p.m.

Account balances not covered by insurance are to be paid in full within 30 days of billing. As an added convenience to you, we accept Visa, MasterCard and Discover Card.

If you anticipate difficulty paying your account in full within 30 days, we do have several payment options available. If you wish to make monthly payments, you must contact the CHN Business Services Department. A signed contract is required to activate a monthly payment plan. Monthly payments will be subject to consumer credit interest charges.

Community Care

Community Health Network does offer financial aid to families who are unable to comply with our payment policy. Specific financial information and verification is required.

For information regarding this program or to inquire about your self pay balance call or email your Representative or complete this form:

Berlin Memorial Hospital and CHN Clinics
      for last name beginning with:
        A - L Maureen   920-361-5596
        M - Z Stewart    920-361-5711
Toll Free: 1-800-236-1283 Ext: 5596 or Ext: 5711

Wild Rose Hospital & Waushara Family Physicians:
Marie 920-622-3257

Group or Private Insurance

Please present all of your insurance information and identification cards when registering. Any balance remaining after all insurance has paid, is due in full from you.

To help speed processing of your account, we ask that you present your health insurance information and identification cards upon registration. If this information was not available at registration, please complete this form.

Our staff of qualified Patient Representatives is familiar with the rules of the insurance filing process. They will submit your bill to your primary and secondary insurance carriers if they have been given the necessary information.

After your insurance has been billed, ample time will be allowed for your insurance payment. The balance remaining after your insurance claim is either paid or denied will be due from you within 30 days of our notification that your claim processing has been completed.

Workers' Compensation

Workers' Compensation claims will be filed after verification with your employer.

Should your Workers' Compensation be denied, your health insurance will be billed.

For additional information about your account if insurance is still pending call or email your Representative or complete this form:

Berlin Memorial Hospital and CHN Clinics

for last name beginning with:

       A - G   Sally      920-361-5712
       H- O Betty      920-361-5716
       P - Z    Jan         920-361-5488

Toll Free: 1-800-236-1283

Wild Rose Hospital & Waushara Family Physicians:
Marie 920-622-3257

Medical Assistance

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:

           Priscilla   920-361-5969
           Debbie     920-361-5542    or send email by clicking on name.
                    Toll Free: 1-800-236-1283 Ext: 5969

Medicare Insurance

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:
     Call or send email by clicking name
         for last name beginning with:
         A - K   Peggy    920-361-5920
         L - R   Karen 920-361-5707
         S - Z    Marnie      920-361-5907

Medicare Supplemental (CHN and WRH/WFP)
        A - E   Ila    920-361-5708
        F - M Grit   920-361-5708
        O - Z   Pat   920-361-5924

For Other Questions or Concerns:
contact Liz 920-361-5511 (or send email)


	CHN Business Services