Obstetrics Prepayment Plan - Bryan Health...Bryan Medical Center Bryan East Campus 1600 S. 48th St....

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Bryan Medical Center Bryan East Campus 1600 S. 48th St. Lincoln, NE 68506-1299 402-481-1111 800-742-7844 bryanhealth.org 298 (Rev. 8/12) Obstetrics Prepayment Plan Obstetrics Prepayment Plan Having a baby is an exciting time for you and your family. At Bryan Medical Center, we want to help you have a pleasant stay and a successful beginning to parenthood. Our Obstetrics Prepayment Plan for your medical center delivery charges can ease some of the anxiety associated with having a baby and add to the joy of this special occasion. Services not covered The plan applies only to billed medical center delivery and well-baby services. You will receive a separate bill from your attending doctor and other doctors who participate in your treatment plan or provide interpretation or consultation for anesthesiology, electroencephalography (EEG), radiology, electrocardiography (EKG), pathology services or consulting physician services.

Transcript of Obstetrics Prepayment Plan - Bryan Health...Bryan Medical Center Bryan East Campus 1600 S. 48th St....

  • Bryan Medical Center Bryan East Campus

    1600 S. 48th St. Lincoln, NE 68506-1299 402-481-1111 800-742-7844

    bryanhealth.org

    298

    (Rev

    . 8/1

    2)

    Obstetrics Prepayment Plan

    Obstetrics Prepayment PlanHaving a baby is an exciting time for you and your

    family. At Bryan Medical Center, we want to help

    you have a pleasant stay and a successful beginning

    to parenthood.

    Our Obstetrics Prepayment Plan for your medical

    center delivery charges can ease some of the

    anxiety associated with having a baby and add to

    the joy of this special occasion.

    Services not coveredThe plan applies only to billed medical center

    delivery and well-baby services. You will receive

    a separate bill from your attending doctor and

    other doctors who participate in your treatment

    plan or provide interpretation or consultation for

    anesthesiology, electroencephalography (EEG),

    radiology, electrocardiography (EKG), pathology

    services or consulting physician services.

  • For those who do not have insurance coverage for delivery and/or well-baby care.

    Obstetrics Prepayment Plan

    For mom’s careBryan Health offers the following financial plan for

    normal or cesarean section delivery services.

    You prepay $2,200 before your admission and Bryan

    will match this with another $2,200 for a total of $4,400

    toward your delivery fees.

    You will need to pay any balance greater than $4,400.

    Arrangements can be made with patient financial

    services if you are unable to make your payment within

    30 days after you are discharged from the hospital.

    For baby’s careYou also may choose to prepay for well-baby care. To do

    this, you must prepay $700 before admission and Bryan

    will match this with $700.

    You are responsible for any charges for your baby’s stay

    that exceed $1,400. Again, arrangements can be made

    with patient financial services if you are unable to pay

    this account in full within 30 days from the time your

    baby is discharged from the hospital.

    Example

    Mother’s bill .................................................................................. $5,000Patient paid ................................................................................... - $2,200Medical center matches ............................................................ - $2,200Balance due .................................................................................. $ 600

    Baby’s bill ...................................................................................... $1,800Patient paid ................................................................................... - $ 700Medical center matches ............................................................ - $ 700Balance due .................................................................................. $ 400

    Total both bills .............................................................................. $6,800Total paid by patient before delivery ...................................... $2,900Total matched by medical center ............................................ $2,900Total remaining balance patient owes ................................... $1,000

    Hospital charges onlyThis plan covers charges for the mother and baby during

    their stay in the hospital. It does not include any doctors’

    bills or other professional services ordered by your doctor.

    You will be billed separately for those services.

    How to enroll in the planComplete this detachable card and return it by mail or in

    person to the cashier at Bryan East Campus.

    If you have questions about this plan, please call patient

    financial services at 402-481-5791.

    We reserve the right to change this plan or rescind

    this offer at any time. We will honor this offer for any

    completed deposits if changes are made.

    Obstetrics Prepayment PlanREGISTRATION

    Please enroll me in the following Obstetrics Prepayment Plan(s):

    o $2,200 plan for medical center delivery services

    o $700 for medical center well-baby care services

    My prepayment is enclosed, and I have read the brochure and understand the plan benefits and matching payment procedure.

    Patient’s name _________________________________

    Address _______________________________________

    City _________________ State ______ Zip __________

    Phone number (day) ____________________________

    Phone number (evening) _________________________

    Email _________________________________________

    Expected due date ______________________________

    Physician’s name _______________________________

    Date form completed ____________________________

    Delivery expected at Bryan Medical Center.

    Detach and return by mail or in person, along withyour payment, to the cashier at the medical center.

    CashierBryan Medical Center

    Bryan East Campus1600 S. 48th St.

    Lincoln, NE 68506-1299