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Billing and Payment Process

Once you are scheduled for your services, if a pre-certification is needed, we will begin that process. We will attempt to reach you to complete your registration, verify your benefits and provide you with an estimate based on your insurance benefits. The pre-certification process will begin at this time.

You may call (937) 499-7364 or (855) 887-7364 to complete the above process at your convenience.

Collection Policy for Out-of-Pocket Expenses

It is Premier Health's (Premier) policy to collect all out-of-pocket expenses due prior to or at time of service. If you are not contacted prior to your date of service, you may be visited by a financial counselor while receiving services to review your benefit package. The financial counselor will inform you of any out-of-pocket expenses for which you may be responsible and collect payment prior to discharge. If you are unable to pay at the time of service, the financial counselor will be able to discuss other payment options with you.

Your Insurance Company

Our Patient Financial Services staff will file your claim with your health insurance plan. (If you are a patient in the emergency room, you will be asked for your co-pay or deductible after the physician has seen you.

Any amount not paid by your health insurance plan within a reasonable amount of time will also be billed to you. If you have questions about your insurance benefits, contact your insurance company.

Your Bill

You might receive several different bills from one visit to Good Samaritan Hospital, including a hospital bill and a physician bill.

  • Your Hospital Bill: This bill reflects your room rate, medication, medical supplies, and services performed by hospital personnel. Upon request, an itemized bill can be sent to you after you are discharged and after we have billed your insurance company.
  • Your Physician Bill: You may receive another bill for professional services provided by physicians, radiologists and other specialists. These physicians interpret EKGs and X-rays and perform other services related to your care.

The physicians are not employees of Good Samaritan Hospital and will bill separately for their services.

If you have questions about a physician bill, contact these organizations directly at the phone number listed on their statement or reference the phone numbers listed below.

Medical Radiologists, Inc.
(937) 296-0253

Prestige Billing Services
(937) 436-4675

Anesthesia Associates
(937) 293-0247 or (800) 827-3458

North Dayton Pathologists, Inc.
(800) 288-8325

Physical Medicine Associates
(937) 298-5536

Billing Cycle

As a service to you, Premier Health's (Premier) Patient Financial Services Office will bill your insurance provider, Medicare, and/or any supplemental health insurance that you have. Please remember that you are ultimately responsible for payment of the account.

You may receive an informational patient statement after your visit letting you know your insurance company has been billed. It will show the amount that was billed to your insurance company. Please read the information in the IMPORTANT MESSAGE box on the statement. That message will indicate whether or not the balance on the statement is due from you or your insurance company.

This statement will be sent to you to let you know if Good Samaritan Hospital has received payment from your insurance provider. If there is no response from the insurance provider, you will get a statement requesting you to contact your insurance company to check on the status of your bill.

After your insurance company has processed the bill, you will receive a patient statement showing the amount that has been paid and any balance that you are required to pay. This information will be reflected in the IMPORTANT MESSAGE box on your statement.

Your insurance company should send you an explanation of your health care benefits (EOB) showing total charges, payments, and any co-payment or deductible amounts you are responsible for paying. If you have questions about your EOB and what your insurance company paid or denied, call the Customer Service representatives at your insurance company.

Please contact us at (937) 208-2777 or (855) 208-2777, Monday through Friday, 8:00 am to 4:30 pm, if you have any questions about your bill or if you need to set up payment arrangements.

Requesting an Itemized Bill

Itemized bills are not automatically sent to patients. However, we are happy to provide one if you request it.

You can call (937) 208-2777 or (855) 208-2777 to get your current balance or request an itemized bill. You will need your account number and last four digits of your Social Security number.