Billing & Financial Services
Indian River Medical Center is a 501(c) 3, not-for-profit hospital that relies on prompt payment of bills to continue providing services to the community. When you are admitted, we ask that you make arrangements for the payment of your bill. This may involve providing necessary insurance information during the admission procedure or establishing another payment arrangement with the Patient Financial Counselor. MasterCard, American Express, Discover or Visa may be used for settlement of the outstanding balances.
Indian River Medical Center Billing Office: (772) 563-4774
IRMC Physician Billing Office: (772) 794-5611 or IRHSbilling@irmc.cc
Patients are responsible for the charges for services received. However, to assist patients in meeting their financial obligations, the hospital will bill their health insurance carrier(s) for them, as long as a valid ID card and/or information regarding insurance coverage is presented at the time of registration.
The hospital accepts assignments of benefits for all contract payors and maintains an active follow-up program with all insurance carriers. Insurance is billed as a courtesy to the patient and the patient remains responsible for contacting their insurance carrier to ensure prompt payment of their accounts. Accounts with balances due after 90 days may be billed to the patient, regardless of pending insurance benefits. Accounts with delinquent balances or without adequate payment arrangements may be forwarded to a collection agency or attorney.
At the patient’s request, a detailed bill may be provided. The hospital will send periodic statements to the patients or responsible party in an effort to keep them informed as to the status of all open accounts.
Compare Hospital Prices
AHCA’s Florida Health Price Finder provides estimated payments for over 200 bundles of care, showing the payment information by each component of care. Health plan claims data are the source for the data on the pricing website.
- The service bundle information is a nonpersonalized estimate of costs that may be incurred by the patient for anticipated services and that actual costs will be based on services actually provided to the patient;
- Patients have a right to request a personalized estimate for the hospital;
- Patients should contact the health care providers anticipated to provide services to the patient while in the hospital to obtain a personalized estimate of their costs, their billing practices and whether they participate in the patient’s health plan;
- For a price estimation of services, call (772) 226-4100.
This publication contains hospital financial data filed with the Agency by hospitals and includes an analysis of hospital financial trends. Click here, then select the section labeled: Florida Hospital Financial Data.
Understanding Your Insurance
Many insurance companies with different levels of coverage exist in today’s healthcare marketplace. It is impossible for us to know exactly what level of coverage you or your employer has purchased.
It is your responsibility to become familiar with the level of coverage you have. The customer service number of your insurance company is usually printed on the back of your card.
We will bill your insurance company based on the information you provide to us during the patient registration process. However, should the bill remain unpaid by your insurance company after 90 days, we may send the bill to you, because you are ultimately the responsible party to pay for services that we provided to you during your care.
We will also send a courtesy billing to your secondary/tertiary insurance companies. However, as stated above, if the balance is outstanding after 90 days, we will bill you and expect prompt payment for services rendered to you.
If you have questions regarding your insurance company’s payment or rejection of a claim, please call the customer service department at your insurance company.
Insurance Plans Accepted at IRMC
Indian River Medical Center accepts Medicare, Medicaid, and the insurance plans listed below. This list is for informational purposes only and is subject to change at any time. Many insurance plans require precertification, requiring the patient to receive prior authorization before receiving care. For questions about insurance coverage and specific plan products, please contact your insurance carrier directly.Skip Insurance Links
- Aetna Comercial
- Aetna Medicare
- Beacon Health Options/Value Options
- Beech Street
- Cigna Behavioral Health
- Florida Blue Blue Select
- Florida Blue Health Options
- Florida Blue Medicare PPO
- Florida Blue Network Blue
- Florida Blue Traditional
- Florida Blue PPC
- CarePlus Health Plan
- Cigna HMO/Gatekeeper/PPO/Great West
- Concordia Behavioral Health
- Coventry Health Care
- Evolutions Healthcare Systems
- Florida Healthy Kids
- Freedom Health Medicaid
- Freedom Health Medicare
- Healthsmart Payors Organization
- Health First Commercial
- Health First Medicare
- Humana Commercial
- Humana Medicaid
- Humana Medicare PPO
- Magellan Complete Care Medicaid
- Magellan Healthcare
- Managed Health Network
- Mental Health Network
- Molina Medicaid
- Stratose/National Preferred Provider Network
- Pomco Group
- Prestige Health Choice Medicaid
- Beacon Health Options/Psychcare
- Rockport Workers Comp
- Simply Healthcare Medicaid
- Sunshine Health Medicaid
- Three Rivers Provider Network
- Optum/United Behavioral Health
- United Healthcare Commercial
- United Healthcare Medicare
- United Healthcare Medicaid HMO
- United Healthcare NHP
- Vocational Rehabilitation
- WellMed Medicare
*As of October 1, 2017.
Medicare and Florida Medicaid
Medicare and Florida Medicaid are both honored by IRMC. Medicare is a federally funded program for those at least 65 years of age and/or disabled. Medicaid is a federal and state funded program, generally for children, mothers and the disabled.
If you have Medicare and Medicaid, we will need a copy of your current card to verify eligibility and process your claim. You should be aware that the Medicare program specifically excludes payment for certain items and services such as cosmetic surgery, some oral surgery procedures, personal comfort items, hearing evaluations and some medicines. Deductibles and co-payments also are the responsibility of the patient.
Financial Assistance Policy (FAP)
Indian River Medical Center’s mission is to provide exceptional, patient-centered, evidence-based healthcare to residents of Indian River County and surrounding areas. To that end, financial assistance is available to the community who are uninsured or underinsured and do not have adequate financial resources to pay for medically necessary healthcare services. At the same time, Indian River Medical Center will provide care for emergency medical conditions to individuals regardless of their eligibility for financial assistance or ability to pay for care.
Charity care is not considered to be a substitute for personal responsibility. In order to manage its resources responsibly and to allow Indian River Medical Center to provide the appropriate level of assistance to the greatest number of persons in need, patients are expected to cooperate with Indian River Medical Center’s procedures for obtaining charity or other forms of payment or financial assistance, and to contribute to the cost of their care based on their individual ability to pay. Payments expected from uninsured patients are consistent with amounts generally billed to Medicare and insurance companies utilizing a look-back methodology.
Types of Financial Assistance
There are a variety of financial assistance programs available to patients after all other resources including applicable health insurance coverage, payment from third party payors and payments from Medicaid, Medicaid HMO plans, or other government sponsored programs have been exhausted. Financial Assistance Programs include the following.
- Charity Care provided by Indian River Medical Center
- Indian River County Hospital District Reimbursement of Indigent Care
- Discounted Services for Catastrophic Care
- Discounted Services for Uninsured patient
- Pay it Forward Fund – This fund was created to help cancer patients who are facing financial difficulties as a result of their cancer illness.
How to Apply for Financial Assistance
Indian River Medical Center provides resources to uninsured and underinsured patients to assist them in completing a financial assistance application. Our financial counselors attempt to make direct contact with uninsured patients to assist them with the application process. If direct contact is not possible, a letter is sent to the patient with instructions on how to apply for financial assistance. The Financial Assistance Application is available on the internet at www.IndianRiverMedicalCenter.com under the Billing and Financial Service link as well as in the Admitting Office, Emergency Room, and other registration sites. In addition, applicants can visit our Financial Counselors at Indian River Medical Center to obtain an application or to receive assistance with completing the application. Our Financial Counselors can be reached at (772) 567-4311, ext. 1169.
Additionally, Indian River Medical Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Indian River Medical Center does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. If you speak with limited English, language assistance services, free of charge, are available to you.
Patients are informed about our Financial Assistance process in a number of ways:
- Financial counselors and Social workers are available to patients during their hospitalization.
- Patient Access Services attempts to contact scheduled patients prior to services to provide patients with their expected amounts due and discuss payment/discount options.
- Discussions about financial assistance occur when speaking to patients on the phone about their account balances.
- Information regarding our Financial Assistance Policy (FAP) is located on our website.
Financial Assistance Determination
Financial Assistance is based on a sliding fee schedule taking into consideration Federal Poverty Guidelines, income, assets, family size, and catastrophic medical costs. Financial Assistance ranges from 58% to 100% of the patient’s bill. Indian River County residents with household income below 150% of the Federal Poverty Guidelines, and without other substantial financial resources and not eligible for Medicaid or other coverage, will be granted free care. Patients with household income between 150% and 400% of the Federal Poverty Guidelines and have a catastrophic medical illness, without other substantial financial resources, and not eligible for Medicaid or other coverage, will be granted an 82% discount. All uninsured patients that do not qualify for one of these programs will receive a 58% discount which is consistent with payments negotiated with insurance companies. No patient eligible for financial assistance under this Policy will be charged more for medically necessary care than the amounts generally billed (AGB) to individuals who have insurance coverage. The amounts generally billed is based on all claims paid in full by Medicare and private health insurers over a 12 month period divided by the associated gross charges for those claims.
Uninsured Patients Billing Practices
Patients in the financial assistance application process: The first statement sent will reflect the expected payment that is consistent with those offered to insurance companies for medically necessary services. In addition, the following statement will be included on the patient’s first notification:
I am writing to you in reference to your recent medical services. Your account was referred to us by Indian River Medical Center to help you apply for programs that may be available to you. If you are found eligible, your hospital bill may be paid.
Patients that are NOT in the financial assistance application process (reasons may vary): The first statement includes the dollar balance that is due and the following message:
If you have insurance that is not filed please furnish Indian River Medical Center with that information and we will file for you.
Patients that have insurance and a claim has already been filed will receive a statement from Indian River Medical Center stating the dollar balance that is due and the following message:
If your insurance had paid, please verify this balance against the Explanation of Benefits your insurance provided you to ensure the balance is correct.
Indian River Medical Center’s second and third messages will notify the patient that they are past due and being considered for placement with a collection agency.
All statements include the following message:
Any payment other than payment in full must be approved in order to keep your account from being considered past due.
Indian River Medical Center has developed policies and procedures for internal and external collection practices that take into account the extent to which the patient qualifies for charity, a patient’s good faith effort to apply for a governmental program and a patient’s good faith effort to comply with his or her payment agreements with Indian River Medical Center. For patients who qualify for financial assistance and who are cooperating in good faith to resolve their hospital bills, Indian River Medical Center may offer extended payment plans. Indian River Medical Center adheres to the laws of the Fair Debt Collection Practices Act and patients are treated with dignity and respect in line with our mission and values.
Indian River Medical Center will make reasonable efforts to assist and determine whether the patient is eligible for assistance under its Financial Assistance Policy (FAP). If patients do not apply for financial assistance and do not pay their balance, the account may be sent to a collection agency. Charity is always preferred to sending patient balances to an agency.
Patient balances, generally, will not be sent to a collection agency prior to 120 days of first statement to patient. Charity consideration will still be given to patients whose balances are with a collection agency.
Prior to sending a balance to the collection agency, the patient will receive a message on the final statement informing them their account is being sent to a collection agency.
In addition, patient accounts may be subject to the following collection actions:
- Credit bureau reporting
- Legal action against patients who do not qualify for assistance and have sufficient assets to cover the unpaid balances. Legal action may result in a lien on property.
What Other Bills Will I Receive?
The hospital bill does not include charges for professional services provided by physicians. Your physician will bill separately for services rendered by him or her. This includes Emergency Department physicians, radiologists, pathologists, surgeons, cardiologists, anesthesiologists and consulting physicians. These providers may or may not offer the same type of financial assistance. Please contact their offices directly to verify whether they will grant full or partial financial consideration. If you have questions concerning their bills, please contact the providers directly.
Indian River Medical Associates – (772) 794-5611
Emergency Physicians of Vero Beach, LLC
- (800) 355-2470 (services between 06/01/2016 – 07/31/2017)
- (772) 794-2570 (services between 08/01/2017 – 1/31/18)
Gilford Sound Emergency Physicians, LLC – (800) 355-2470 (services effective 2/1/18 – present)
Anesthesia of Indian River – (877) 565-6865
Radiology Physicians of Indian River – (855) 666-9508
Financial Assistance Application
Financial Assistance Policy
Financial Assistance Policy – Spanish
Application for Financial Assistance
Application for Financial Assistance – Spanish
Financial Assistance Summary
Financial Assistance Summary – Spanish
Financial Information Release
Financial Information Release – Spanish
Indebtedness and Living Expenses
Indebtedness and Living Expenses – Spanish
IRCHD Care Program – Spanish
Policy and Procedure Manual
Pay My Bill
Frequently Asked Questions
- What’s the best way for me to pay my hospital bills?
- What is a deductible? A co-payment?
- Who is responsible for paying my bill?
- What other bills will I receive?
- How do I view my account information and manage my account online?
- What is a Guarantor Number?
- Can another family member access my online account?
- Can I still receive my paper statements if I enroll for online account management?
- Why is my e-mail address needed?
- Can I contact the Patient Accounting office through e-mail?
- Do I need to enroll in order to use these other resources?
- Will I be able to combine several open accounts for my different visits and pay them at once?
- Will I be able to view and pay my physician bills from the site?
- Do I need to establish an electronic payment method to be eligible for the online account manager?
- What specific type of electronic payment method can I use?
- Can I print a payment stub and send it in with my payment instead of paying electronically?
What’s the best way for me to pay my hospital bills?
When making medical payment decisions, make sure you know:
- the total costs
- what your insurance will cover
- what you will have to pay out-of-pocket
- what method of payment the hospital accepts
- if you or your hospital physician’s office staff will be completing insurance forms
What is a deductible? A-co-payment?
- A deductible is the initial amount of “covered” health costs that you pay before your insurance plan begins reimbursement. A deductible is usually a set dollar amount such as $250 or $500.
- A co-payment is the portion of your health care expenses not covered by insurance. A co-payment is usually a percentage figure, like 10% or 20%.
For example, on a $500 bill, your deductible might be $150, so you would have to pay the first $150. This leaves a balance of $350. Of that $350, your co-payment might be 20%, meaning that you will have to pay an additional $70. Your insurance company will pay the remaining $280.
Once you have this information, there is a number of ways for paying your bill:
- If your insurance pays all but a deductible or co-payment, you will be required to pay an estimate of your portion of the bill at the time of service.
- The hospital will file the claim for you. After insurance has made payment, you will receive a bill asking for payment on the balance using cash, check, or credit card.
- In certain circumstances, you will be able to make monthly payments to the hospital until your bill is paid in full. You should discuss this with our Patient Accounts Department.
- Make sure that you understand what the hospital requires and what payment options you have.
Who is responsible for paying my bill?
The hospital will bill your insurance company directly (unless you specify otherwise), you are ultimately responsible for making certain that your bill is paid.
What other bill(s) will I receive?
In addition to your bill from the hospital, you may receive bills from other physicians who may have provided services to you. For instance, you may receive bills from consulting physicians, radiologists, or other specialists. Please contact their office directly if you have questions concerning their bills.
The hospital bill does not include charges for professional services provided by physicians. Your physician will bill separately for services rendered by him or her. This includes Emergency Department physicians, radiologists, pathologists, surgeons, cardiologists, anesthesiologists and consulting physicians. Payment for physician services can be made directly to the physician.
If you have certain tests or treatments in the hospital, you may receive bills from physicians you did not see in person. These bills are for professional services rendered by these doctors in diagnosing and interpreting test results while you were a patient. Pathologists, radiologists, cardiologists, anesthesiologists and other specialists perform these services and are required to submit separate bills. Payment for such services is to be made directly to the physicians. If you have questions about these bills, please call the number printed on the statement you receive from them.
Additionally, not all physicians that have privileges at Indian River Medical Center are considered in-network with the insurances Indian River Medical Center is contracted with. Patients should contact their insurance carrier directly for information about in-network physicians.
Providers you may receive separate for bills from:
- Indian River Medical Associates – (772) 794-5611
- Emergency Physicians of Vero Beach, LLC –
- (800) 355-2470 (services between 06/01/2016 – 07/31/2017)
- (772) 794-2570 (services after 08/01/2017)
- Anesthesia of Indian River – (877) 565-6865
- Radiology Physicians of Indian River – (855) 666-9508
How do I view my account information and manage my account online?
In order to view your account information and make payments online, you must enroll by entering your Guarantor number, account number, social security number, e-mail address and a password on the enrollment page. This information will ensure that only you can securely access your account information. Once enrolled, you will receive an e-mail notification whenever there is a change to your account.
What is a Guarantor Number?
The Guarantor is the person responsible for payment of the account. Each Guarantor is given a Guarantor Number, which is printed on your paper statement. This number provides the access to your account information and is required to enroll for your online account. Once you are enrolled, you will only need to enter your social security number to access your account.
Can another family member access my online account?
A family member can only access your account if you provide that person with your Guarantor Number and password. If two family members are responsible for payment of accounts, then each person will have a different Guarantor Number and be required to enroll separately.
Can I still receive my paper statements if I enroll for online account management?
Yes. During the enrollment process, you will be asked if you would like to receive your statements online only, or continue receiving your statements through the mail. At any time, you may go to your patient profile in the ‘My Account’ section to change your preference.
Why is my e-mail address needed?
We collect your e-mail address so we can notify you when there is activity in your account, such as insurance payments received, balance now due from you, or if for some reason one of your accounts has become past due.
Can I contact the Patient Accounting office through e-mail?
Do I need to enroll in order to use these other resources?
No, you only need to enroll if you would like access to ‘My Account’ information, including making payments, tracking insurance, receiving e-mail notifications when there is a change to your account, etc. The other resources are available to you 24 hours a day, regardless of your enrollment.
Will I be able to combine several open accounts for my different visits and pay them at once?
Yes, as long as the accounts are within the same hospital, and are open, you will be able to view the billing information for each visit and pay with one click. If you have open accounts across more than one hospital, you will need to make separate payments.
Will I be able to view and pay my physician bills from the site?
Do I need to establish an electronic payment method to be eligible for the online account manager?
What specific type of electronic payment method can I use?
Can I print a payment stub and send it in with my payment instead of paying electronically?
Yes. You have the option of printing a payment stub with all of your open accounts and sending that in with your check to the hospital. Just click the ‘Print Payment Stub’ option on the ‘Make Payment’ page.