Beyond your name and policy number, your insurance card contains important information.

Some is so important that if you don't know it, you may be required to pay extra money.Many insurance companies list special instructions on the card about pre-certification or prior authorization for services. That means you are required to contact the company before or at the time you're admitted to the hospital (even for an emergency admission) and before or at the time you register for any other hospital services.

Check your card. If it shows that you must call your insurance company for authorization, please make sure that you or a member of your family phones the company without delay. (Usually you must do so within 24 hours.)

At CHI St. Luke's Health, we want to assist you in coping with your financial requirements. Therefore, we remind you that each insurance company has its own requirements - and you may incur added expense if you do not meet those requirement. Please refer to the set of questions on the back of this form as you deal with insurance requirements.

To meet your insurance requirements, ask yourself:

  • Have you read the information on the front and back of all your (and your spouse's) insurance cards?
  • If you are required to gain pre-certification, have you called your insurance company?
  • If you've called your insurance company, have you given the hospital your approval number?
  • Do you know if physician and hospital charges will be covered by your insurance company?
  • If your policy has a deductible, how much is it?
  • If your policy requires a second medical opinion, have you gotten it?
  • If your policy requires a co-payment, how much is it?
  • If your policy requires a referral form for health services, have you gotten it and given it to the hospital's admissions office?
  • If your policy requires a claim form, have you filled it out?>
  • If you are scheduled for surgery, is it related to an accident? If so, have you given the hospital all information about when, where, and how the accident happened?
  • Are you covered by more than one insurance plan? If so, have you given the hospital all information about all plans' including plan name, address, phone number, ID number, enrollee's date of birth, completed claim form and/or completed referral form?