BILLING AND INSURANCE INFORMATION

    We know most medical costs are unexpected, and understanding your medical bills can be complicated. The Southwestern Vermont Medical Center  (SVMC) financial team wants to help you meet your health care needs. Friendly and professional billing specialists and a financial counselor are available to help answer your questions.

    To receive personalized answers for your questions, call the Billing Department at 802-447-4500 or Financial Counseling at (802) 440-4083 today.

    You can also visit the Patient Billing department. It is located on the first floor of the hospital and is open 8 a.m. – 4:30 p.m.

     

    We are eager to help you answer your billing and insurance questions. The most common questions include: 

    The number that appears on your bill is the best one to call. If you have lost your bill or do not have it with you, call (802) 447-4500. With a few pieces of information, our billing specialists can answer your questions or provide the correct number. 

    Southwestern Vermont Medical Center (SVMC) is committed to price transparency and helping our patients make informed decisions about their care. In accordance with federal law, SVMC has made available our standard charges and reimbursement information for each inpatient or outpatient service or item provided to our patients.  In addition, SVMC is introducing a new online price estimation tool to help our patients estimate the cost of their care.

    SVMC has a price estimation tool to help you determine out-of-pocket costs for care by using real-time insurance benefit information. This tool provides cost estimates for at least 300 common hospital services and procedures provided at SVMC. The estimator tool is not a guarantee of eligibility, coverage or payment.  Your specific insurance coverage will ultimately determine the amount you owe, including any deductible, copay, coinsurance or out of pocket maximums.  Please refer to your health plan documents or contact your insurance plan for details of your insurance coverage.

    If you cannot find a service you are looking for, are having trouble obtaining an estimate or have questions regarding your estimate please contact the SVMC billing office at 802-447-4500.

    SVMC understands that paying for health care can be a financial burden. To help, SVMC has a financial assistance program available for patients. SVMC has financial counselors available to help answer questions regarding financial assistance or for help applying for health insurance. For assistance please contact the billing office at 802-447-4500.

    Hospital and procedure estimates are based on information available at the time and not a guarantee of the final billed charges.

    Your actual costs may be different than the estimate for various reasons, including time spent in surgery, specific supplies or medications used, and/or special care required for your specific medical condition.

    Standard Charges
    A Charge Description Master (CDM), also referred to as a charge master is a comprehensive listing of services or items that are billable to a patient or insurance provider. The SVMC charge master includes standard charges for services performed and billed by SVMC. The information provided below is based on SVMC standard charges and information we have gathered from contracts with managed care insurance plans.  The charge file contains the following standard charges for all items and services: gross charges, discounted prompt pay cash prices, payer specific negotiated charges, and de-identified minimum and maximum negotiated charges.  The various payers contained in the file have different payment methodologies, some payers reimburse per service or item billed while others reimburse based on service packages or bundled services.  A single visit or procedure may involve multiple different charges from the charge master. The standard charges shown in the charge master do not necessarily reflect what a patient will be responsible to pay. Patient out of pocket costs are determined by the patients’ health insurance based on the patient’s specific benefit and hospital contract.  Due to the complexity of the charge master and reimbursement information; If you are having a procedure at SVMC, we encourage you to contact the billing office at 802-447-4500 to request an estimate specific to the care you will be receiving.

    Download SVMC Standard Charges

     

    Effective January 1, 2022, the No Surprises Act, which Congress passed as part of the Consolidated Appropriations Act of 2021, is designed to protect patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities, holding them liable only for in-network cost-sharing amounts. The No Surprises Act also enables uninsured patients to receive a good faith estimate of the cost of care.

    YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS
    When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and or deductible.

    What is “balance billing” (sometimes called “surprise billing”)?
    When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your plan’s network.

    “Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what you plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count towards your plan’s deductible or annual out-of-pocket limit.

    “Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care – like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

    You’re protected from balance billing for:

    Emergency services
    If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balance billed for these post-stabilization services.

    Certain services at an in-network hospital or ambulatory surgical center
    When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

    If you get other types of services in these in-network facilities, out-of-network providers can’t balance bill you unless you give written consent and give up your protections.

    You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

    When balance billing isn’t allowed, you also have these protections:

    • You’re only responsible for paying the share of the cost (like copayments, coinsurance, and deductible) that you would pay if the provider or facility was in-network. Your health plan will pay any additional costs to out-of-network providers and facilities directly.
    • Generally, your health plan must:
    1. Cover emergency services without requiring you to get approval for services in advance (also known as “prior-authorization”). 
    2. Cover emergency services by out-of-network providers.
    3. Base what you owe the provide or facility (cost-sharing) on what it would pay in-network provider or facility and show that amount in your explanation of benefits.
    4. Count any amount you pay for emergency services toward your in-network deductible and out-of-pocket limit.

    If you think you have been wrongly billed, you may contact the U.S. Centers for Medicare and Medicaid Services (CMS) No Surprises Helpdesk at 1-800-985-3059 or visit https://www.cms.gov/nosurprises for more information about your rights under federal law.

    Good Faith Estimates
    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 costs 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 1 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 1-800-985-3059

    Check your bill for online and pay-by-mail options. If you have lost your bill or do not have it with you, reference the addresses below:

    Hospital Billing:
    Account number on your bill begins with "H."
    P.O. Box 1361
    Williston, VT 05495
    (802) 447-4500
    Online at:  https://svhealthcare.patientsimple.com/guest/#/index

    Physician Office Billing:
    Account number on your bill ends in "A3744"
    P.O. Box 5732
    Belfast, ME 04915
    (802) 440-4213
    Online at: www.quickpayportal.com

    If you don’t know whether your bill came from the hospital or from a physician’s office, call (802) 447-4500. With a few pieces of information, our billing specialists can provide the proper address.

    SVMC bills all insurance companies. However, SVMC does not have contracts with all insurance companies. Without a contract some insurances will not pay SVMC directly. In these cases, patients are responsible for paying SVMC and collecting reimbursement from their insurance.

    SVMC has contracts with the following insurance plans:

    • Aetna PPO
    • Blue Cross and Blue Shield of Vermont
    • Blue Cross and Blue Shield of Massachusetts (Indemnity and PPO)
    • BMC Healthnet Plan
    • CDPHP
    • CDPHP Medicaid
    • CDPHP Exchange/Essential Plans
    • CDPHP Medicare Advantage
    • Cigna
    • Fidelis Medicaid, Child Health Plus, HARP
    • Fidelis Medicare Advantage
    • Fidelis NY Exchange/Essential Plan
    • Harvard Pilgrim Health Care (Commercial Plans)
    • Health New England HMO, PPO, Medicare, Exchange
    • Humana Medicare Advantage
    • Martins Point
    • MA Medicaid (Hospital Services only)
    • Medicare
    • MVP HMO/PPO/EPO
    • MVP Medicare Advantage
    • MVP Exchange/Essential Plan
    • MVP Medicaid, Child Health Plus, HARP
    • NY Medicaid
    • Tufts HMO/PPO (Commercial plans)
    • United Healthcare HMO/PPO (Commercial Plans)
    • United Healthcare Medicare Solutions
    • Vermont Medicaid
    • Wellcare Medicaid
    • Wellcare Medicare Advantage

    SVMC understands that health care is expensive and that paying for it can be a financial burden. To help, SVMC has a financial assistance program available for patients. Financial assistance includes arranging payment plans and helping patients apply for charity care. For a financial screening to see what assistance you qualify for, call financial counseling at (802) 440-4083 8 a.m. – 4:30 p.m. weekdays.

    Yes. If you are having difficulty paying an entire medical bill at once, you can set up a payment plan right away. The Billing Department can develop a plan that makes sense for you. Call (802) 447-4502 8 a.m. – 4:30 p.m. weekdays.

    From its very beginning, SVMC has provided care for community members, regardless of their ability to pay. Even today, SVMC has policies for providing free or reduced-cost care to those who need it. Click to access the financial guidelines and application. For questions and help with your application, call financial counseling at (802) 440-4083 8 a.m. – 4:30 p.m. weekdays.

    100 Hospital Drive, Bennington, VT 05201
    (802) 447-4500

    Office Hours:
    Monday – Friday:   8 a.m. – 4:30 p.m.

    Parking:
    To visit the Billing Department, park in parking area P6. 

    Theme picker


    Theme picker


    Our Services

    PARTNERSHIP IS POWERFUL MEDICINE

    A commitment to excellence and a patient-centered approach sets Southwestern Vermont Health Care apart.

     Cancer Care
     Orthopedics
     Emergency
     Maternity
     Primary Care
     ExpressCare
     Cardiology
     Rehab & Residential Care
    View All Services

    Theme picker

    Theme picker

    Theme picker