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Bryan Medical Center Bryan East Campus
1600 S. 48th St. Lincoln, NE 68506-1299 402-481-1111 800-742-7844
bryanhealth.org
298
(Rev
. 8/1
2)
Obstetrics Prepayment Plan
Obstetrics Prepayment PlanHaving a baby is an exciting time for you and your
family. At Bryan Medical Center, we want to help
you have a pleasant stay and a successful beginning
to parenthood.
Our Obstetrics Prepayment Plan for your medical
center delivery charges can ease some of the
anxiety associated with having a baby and add to
the joy of this special occasion.
Services not coveredThe plan applies only to billed medical center
delivery and well-baby services. You will receive
a separate bill from your attending doctor and
other doctors who participate in your treatment
plan or provide interpretation or consultation for
anesthesiology, electroencephalography (EEG),
radiology, electrocardiography (EKG), pathology
services or consulting physician services.
For those who do not have insurance coverage for delivery and/or well-baby care.
Obstetrics Prepayment Plan
For mom’s careBryan Health offers the following financial plan for
normal or cesarean section delivery services.
You prepay $2,200 before your admission and Bryan
will match this with another $2,200 for a total of $4,400
toward your delivery fees.
You will need to pay any balance greater than $4,400.
Arrangements can be made with patient financial
services if you are unable to make your payment within
30 days after you are discharged from the hospital.
For baby’s careYou also may choose to prepay for well-baby care. To do
this, you must prepay $700 before admission and Bryan
will match this with $700.
You are responsible for any charges for your baby’s stay
that exceed $1,400. Again, arrangements can be made
with patient financial services if you are unable to pay
this account in full within 30 days from the time your
baby is discharged from the hospital.
Example
Mother’s bill .................................................................................. $5,000Patient paid ................................................................................... - $2,200Medical center matches ............................................................ - $2,200Balance due .................................................................................. $ 600
Baby’s bill ...................................................................................... $1,800Patient paid ................................................................................... - $ 700Medical center matches ............................................................ - $ 700Balance due .................................................................................. $ 400
Total both bills .............................................................................. $6,800Total paid by patient before delivery ...................................... $2,900Total matched by medical center ............................................ $2,900Total remaining balance patient owes ................................... $1,000
Hospital charges onlyThis plan covers charges for the mother and baby during
their stay in the hospital. It does not include any doctors’
bills or other professional services ordered by your doctor.
You will be billed separately for those services.
How to enroll in the planComplete this detachable card and return it by mail or in
person to the cashier at Bryan East Campus.
If you have questions about this plan, please call patient
financial services at 402-481-5791.
We reserve the right to change this plan or rescind
this offer at any time. We will honor this offer for any
completed deposits if changes are made.
Obstetrics Prepayment PlanREGISTRATION
Please enroll me in the following Obstetrics Prepayment Plan(s):
o $2,200 plan for medical center delivery services
o $700 for medical center well-baby care services
My prepayment is enclosed, and I have read the brochure and understand the plan benefits and matching payment procedure.
Patient’s name _________________________________
Address _______________________________________
City _________________ State ______ Zip __________
Phone number (day) ____________________________
Phone number (evening) _________________________
Email _________________________________________
Expected due date ______________________________
Physician’s name _______________________________
Date form completed ____________________________
Delivery expected at Bryan Medical Center.
Detach and return by mail or in person, along withyour payment, to the cashier at the medical center.
CashierBryan Medical Center
Bryan East Campus1600 S. 48th St.
Lincoln, NE 68506-1299