The following online resources are designed to help patients and their family members or loved ones better understand important health insurance coverage information and the cost of behavioral health treatment.
Oceans Behavioral Hospital is dedicated to providing high-quality, safe and compassionate behavioral health care. We currently accept Medicare, Medicaid, Veterans Administration, TRICARE and all major commercial and Medicare Advantage insurance.
If you or a loved one are referred to our facility, our dedicated admissions professionals will attempt to verify health insurance benefits based on the information provided or available at the time of admission. However, it is important for patients or patient representatives to work closely with the patient’s insurance provider to understand the details of the health insurance coverage.
Important notes about Oceans’ billing process:
If you need assistance understanding your health insurance coverage details, please contact your insurance provider directly.
If you have questions regarding your Oceans bill, or you would like to speak to a financial counselor about payment options, please contact the Oceans billing office at 337-210-3271.
What is the patient’s payment responsibility?
You will likely need to pay a deductible for any services provided during your hospital stay. Deductible amounts will vary depending on your insurance plan but will generally be a set dollar amount.
Once the deductible is met, your insurance provider will usually pay a percentage of the allowable amount for the service. The remaining amount is called coinsurance. It is generally a percentage and is billed to the patient. For example, on a $5,000 bill, your deductible might be $1,350, so you would have to pay the first $1,350. This leaves a balance of $3,650, of which your co-payment might be 20 percent. This means you would have to pay an additional $730 (20 percent) before your insurance would cover the rest of the cost.
A co-payment is a fixed amount you pay for an office visit or other covered health care service, usually at the time you receive the service. The amount will vary depending on the type of service.
How will my insurance company get billed?
As a courtesy, we will bill both your primary and secondary (if applicable) insurance providers. To ensure proper and prompt processing of your insurance payment, please be sure to verify the insurance information we have on file at the time of admission.
How will I know how much I owe?
Your insurance provider will send you an Explanation of Benefits (EOB) notice that details the amount it has paid, any non-covered or denied amounts and the remaining balance. Review your EOB carefully and call your insurance provider or an Oceans billing representative if you have questions.
How often will I receive a statement from Oceans?
Oceans statements are issued monthly after receipt of payment from your insurance provider.
What other bill(s) will I receive?
In addition to your bill from the hospital or intensive outpatient program, you may receive bills from other physicians who have cared for you. For instance, you may receive bills from psychiatrists, medical doctors or other specialists. Please contact their offices directly if you have questions concerning their bills.
Who should I contact if I have questions or need help paying my bill?
Please contact our billing office at 337-210-3271 to discuss any questions or to speak with a financial counselor about payment options.
In addition to making available a list of standard charges (sometimes called a chargemaster) for all services provided at the facility, the Centers for Medicare and Medicaid Services now requires hospitals to disclose negotiated rates with various insurance providers and discounted cash prices to patients without insurance. To comply with these regulations, Oceans Healthcare facilities have provided pricing data for two services – an inpatient psychiatric hospitalization and intensive outpatient services. This information is current as of its posting and will be updated annually, as the rule requires.
What is a charge?
A hospital charge is a federally-required maximum “list price” for an item or service that does not reflect any negotiated discount by the insurance provider.
Hospitals are required to maintain a catalog of procedures, descriptions and list prices in a complex accounting tool, known as the hospital chargemaster.
Although virtually no one pays the full charge amount, federal regulations require hospitals to apply the full list price (or charge) to all patients who receive an item or service.
How are charges different from actual insurance payments?
Medicare, Medicaid and commercial insurance providers determine what they will pay for medical services. In most cases, what your insurance company sets as the reimbursement will be less than the hospital charge.
For example, the charge for staying in a hospital room for one day may be $1,500, but the reimbursement from an insurance provider may only be $700.
How are charges different from your possible out of pocket costs, like your deductible or co-insurance?
Deductibles and co-insurance amounts (explained further in Frequently Asked Billing Questions) are based on the reimbursement terms set by your insurance provider for covered services. They are rarely ever based on the actual hospital charges.
How can you receive a clearer customized estimate of your actual out of pocket costs?
For more information about your potential out-of-pocket costs, please contact your insurance provider prior to receiving care. Please contact Oceans Healthcare’s billing office at 337-210-3271 to discuss any Oceans-specific questions or to speak with a financial counselor about payment options.
Click on your hospital to download the list of standard charges and negiotiated rates for services at that facility.
If you are having a medical emergency, please call 9-1-1.
Please do not request emergency medical services via this contact form.
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5360 Legacy Drive
Bldg. 2, Suite 101
Plano, TX 75024
PHONE (972) 464-0022
FAX (972) 464-0021
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