Billing, Insurance, Financial Assistance
Medical bills, insurance forms, and other related forms and paperwork can be overwhelming. For help with Billing, Insurance and Financial Assistance, please contact our Finance Department at 707.935.5325.
No Surprises Act
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. Billing Disclosures – Your Rights and Protections Against Surprise Medical Bills: When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. Additional information for the No Surprise Act (pdf) – English / Spanish
Sonoma Valley Hospital is committed to meeting the healthcare needs of those who are unable to pay for medically necessary or emergency care because they are uninsured, under-insured, or ineligible for a government program based on their financial situation. Consistent with our mission to maintain, improve, and restore the health of everyone in our community, SVH will ensure that the financial capacity of people who need healthcare services does not prevent them from seeking or receiving care at our facility. Financial assistance is not considered to be a substitute for personal responsibility, and patients are expected to cooperate with SVH’s procedures for obtaining financial assistance, and to contribute to the cost of their care based upon their individual ability to pay. For Financial Assistance, please contact our Finance Department at 707.935.5325 where they will be happy to assist you.
SVH accepts a range of insurance plans. Our staff can assist you and make sure you have all the information you need when you need it. When contacting us, please have your insurance card available.
To assist you in budgeting for your healthcare experience at Sonoma Valley Hospital, here are two ways to obtain help in estimating costs:
Contact your insurance company:
Your insurance company will let you know if a service is a covered benefit, if SVH is an in-network provider, and how much you need to pay if you have a deductible or an out-of-pocket expense before your insurance company contributes to your bill.
Obtain an estimate From Sonoma Valley Hospital before your scheduled visit or stay:
Elective surgical and gastrointestinal (GI) procedures: Contact Pre-Registration at 707.935.5350 to receive a billing estimate before you receive services.
Outpatient Medical Imaging services such as CT-Scan, X-Rays, Ultrasounds, MRI, and Mammography: contact Pre-Registration at 707.935.5008 to receive a billing estimate before you receive services.
Outpatient Services such as Cardiopulmonary, Wound Care, and Speech Therapy: contact Pre-Registration at 707.935.5258 to get a billing estimate before you receive services.
Sonoma Valley Hospital provides reliable cost estimates of services and procedures. Depending upon your situation, we can provide an estimate of your out-of-pocket expenses such as deductibles, co-payments, or any financial assistance for which you may be eligible.
You will find the estimate information available through our Finance Department. This is informational only. It is not a guarantee of the final billing charges or related financial responsibility. Your actual bill and responsibility may vary from the cost estimate based upon your medical condition, unknown circumstances, complications, final diagnosis and recommended treatment ordered by your physician.
Prices will vary and reflect differences among specific payers due to regulations and negotiations with health providers.
It is possible that you will receive services from other healthcare professionals while you are being cared for at our hospital. Those services will be billed separately.
Charge Description Master & Diagnostic Related Group
SVH Charge Description Master (CDM): The Charge Description Master (CDM), or chargemaster, is a comprehensive listing of items that could be billed to a patient, payer, or healthcare provider. The CDM is updated annually and it represents the hospital’s comprehensive list of services, items and supplies that are billable for inpatient and outpatient visits and stays. The prices shown are amounts set before any discounts. Hospitals are required to post charges as the starting point for all billable items. The prices on this list are for Hospital supplies and services only and are gross charges they do not represent your out-of-pocket expenses or specific contracted rates for any SVH payers, including Medicare.
SVH Diagnostic Related Group (DRG): The Diagnostic Related Group (DRG) is the payment system which is referred to as the Inpatient Prospective Payment System. This is established by the Centers for Medicare and Medicaid Services and categorizes each diagnosis by the average resources used to treat Medicare patients for a specific inpatient diagnosis. This is an electronic file, updated annually, that represents the assigned DRG 3-digit code, its description and the SVH average charge for that diagnosis.