/policies/,/policies/administrative/,/policies/administrative/uw-health-administrative/,/policies/administrative/uw-health-administrative/fiscal-affairs/,

/policies/administrative/uw-health-administrative/fiscal-affairs/211.policy

201607211

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UWHC,UWMF,

Policies,Administrative,UW Health Administrative,Fiscal Affairs

Prepayment for Elective Services (2.11)

Prepayment for Elective Services (2.11) - Policies, Administrative, UW Health Administrative, Fiscal Affairs

2.11

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Administrative (Non-Clinical) Policy
This administrative policy applies to the operations and staff of the University of Wisconsin Hospitals and
Clinics Authority (UWHCA) as integrated effective July 1, 2015, including the legacy operations and
staff of University of Wisconsin Hospital and Clinics (UWHC) and University of Wisconsin Medical
Foundation (UWMF).
Policy Title: Prepayment for Elective Services
Policy Number: 2.11
Effective Date: August 1, 2016
Chapter: Fiscal
Version: Revision
I. PURPOSE

To implement a policy and procedure requiring prepayment for certain elective services usually not
covered by health care insurance programs. The patient is to be held responsible for payment in advance
of actual treatments to avoid misunderstanding, complicated billing arrangements and difficult collection
problems.

II. POLICY ELEMENTS

Individuals requesting elective services not covered by insurance must prepay 100% of the estimated total
charges prior to admission or treatment. These elective services include, but are not limited to, procedures
related to infertility, sterilization, and cosmetic surgery.

Many other procedures, particularly those of an elective nature, require prior authorization from the
Wisconsin Department of Health Services to be reimbursed. A comprehensive list of those procedures,
grouped by service, can be located in the Forward Health All Provider Handbook. Charity Care is not
extended for these services.

III. FORMS USED

Patient Estimate letter

IV. PROCEDURE
A. Because of the elective nature of the procedure, payment must be made prior to admission with
an Admissions Representative. The department secretary will provide the Admissions
Representative with the name of each patient, the procedure to be performed and the scheduled
procedure date.
B. The Admissions Representative will inform the patient of the estimated cost (obtained from Price
Line) of the services, and request payment in full prior to admission or treatment if it is
determined that the bill will not be covered by insurance. The Admissions Representative must
notify patients that the price provided is only an estimate and will vary based on the needs of each
patient. The patient will also receive the estimate in writing from Price Line. The Admissions
Representative will work with the patient as necessary to verify any insurance benefits.

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C. Admissions will monitor all elective procedures in which insurance has not been verified or pre-
payment has not been made. Prior to the scheduled procedure, the Patient Account Representative
or Admissions Representative will notify the department secretary of the status of payment
arrangements. If the patient has not made appropriate arrangements or if insurance cannot be
verified, the procedure will be delayed and the patient will be so notified by Admissions.
D. Questions or problems occurring on an individual basis should be referred to Admissions
management.
V. COORDINATION

Sr. Management Sponsor: SVP, CFO UWHC/Chief Administrative Officer/ CFO UWMF
Author: VP, Revenue Cycle; Director of Access Services

Approval Committee: UW Health Administrative Policy & Procedure Committee

SIGNED BY

Elizabeth Bolt
UW Health, Chief Administrative Officer


Revision Detail:

Previous revision: 082013
Next revision: 082019