Chippewa County-Montevideo Hospital and Medical Clinic

A. PRECERTIFICATION: Most insurance companies now require precertification for hospital admissions. The PATIENT is responsible for seeing that this is done. The hospital will help YOU do this if you would like our assistance.

B. BILLING: You will receive a bill from the HOSPITAL for the use of our facilities and overhead, supplies, diagnostic tests, emergency room, physician charges, hospital personnel (i.e. nurses, techs, medical records services, housekeepers), etc. You may also receive bills from one or more of the following for their professional services rendered.

*Please note* The Hospital does not bill insurance payors for the above businesses. You will have to consult them about their billing procedures.

C. INSURANCE: If you provide us with your insurance information, we will file your Hospital claim with the following providers.

*Please note* The patient's share of the bill is due at the time of discharge. This includes deductibles, co-insurance, birth certificates, and non-covered items. You will be assessed a finance charge of 1-1/2% monthly (18% annually) on the unpaid balance.

1. We are a provider for MEDICARE, BLUE CROSS, and MEDICAL ASSISTANCE. They will pay the Hospital directly for any covered charged submitted. After your initial billing, you will not receive another statement until after payment has been received from Medicare, Blue Cross, or Medical Assistance. You will then be billed for finance charges on any remaining balance on your monthly statements.
2. COMMERCIAL INSURANCE. We will need an assignment of benefits signed prior to submitting charges on you behalf to your insurance carrier. If your insurance company has not paid the Hospital within thirty (30) days, we expect that you will take full responsibility for the bill, and you will be billed finance charges.

If your insurance company is causing you unnecessary delays, we would be happy to assist you in resolving these issues, or you could write to the insurance commissioner at the following address:

Minnesota Commerce Department
Enforcement Division
133 East 7th Street
St. Paul, MN 55101
Phone: 1-800-652-9747

*Please Note* You are still responsible for payments as listed on the following page until your account is paid in full.

3. We will allow thirty (30) days for payment from WORKER'S COMPENSATION, after which time the patient will be billed.
4. We will not become involved in disputes arising from personal injury. Financial responsibility for our services always rests with the patient.

D. PAYMENT OPTIONS FOR THE AMOUNTS NOT COVERED BY INSURANCE: We offer various options for payment of the portion of your account not covered by a third party payor. Of course, we would like to see you pay your account in full at the time of discharge, but realize that this is not possible in everyone's case.

Smoking is always a fire hazard. Smoking is not allowed at Chippewa County-Montevideo Hospital and Medical Clinic..

If there is a fire, a panel indicator at the information desk will show its location. Automatic smoke barriers close off individual areas when activated. The Montevideo Fire Department is automatically alerted.

A safety committee established by our medical facility meets monthly to help ensure the safety of all Chippewa County-Montevideo Hospital and Medical Clinic patients, employees and visitors.

If you see a fire, contact your nurse or other employee immediately.

The Health Information Services Department maintains a complete and permanent record of the care and treatment of all patients. These records are necessary to ensure the safety and quality care of all our patients.

The contents of a medical record are strictly confidential and will not be released to anyone without patient authorization except when required by law.

Hospice is a concept of caring for a person and family experiencing the last stages of a terminal illness. This service is provided by well-trained staff. Referral may be made by the patient's physician or by anyone else by calling the Hospice Coordinator at the hospital. It will be determined if the patient and family meet the admission criteria. Hospice staff is on call 24 hours a day/7 days a week.

The Hospital Auxiliary has active membership. Volunteers are available to assist with the following services:

• Provide pink and blue infant caps for newborns, and special Christmas stockings to wear home during the month of December
• Donate items to the gift case.
• Serve nutritional snacks during Mini Health Fairs and tray favors during the holidays.
• Purchased three hospital beds for use in the home.
• Donate equipment to various departments of the hospital.
• Decorate Christmas trees in the hospital during the holiday season.
• Help coordinate services for the hospital and childsafe programs.
• Donate scholarships to graduating seniors in the field of Human Services.

If you have a medical condition or live alone, you and your family can get the security you need by installing a Mainstreet Messenger unit in your home. After the service is installed, a mere press of a button on a device worn on your belt or around your neck will alert a first responder immediately, even though you are unable to get to a telephone. Call MN Valley REC at 1-800-247-5051 or 320-269-2163 for more details.

Third and fourth-year medical students from the University of Minnesota work with the Montevideo Clinic staff through the University of Minnesota Family Practice Center.

All medical students work under the guidance of qualified doctors.

The nursing staff carries out the health care program prescribed by your physician. Supervised patient care is provided by registered nurses. Licensed practical nurses, nursing assistants and ward secretaries work under the supervision of the registered nurses.

One of the important factors in patient identification, is the bracelet placed on your wrist when you are admitted. This bracelet is for your protection and should be worn throughout your stay. If problems arise, please contact your nurse.

Chippewa County-Montevideo Hospital and Medical Clinic has established a procedure whereby patients may issue complaints or grievances related to the Patient's Bill of Rights or any other rights. Grievances or complaints will, if at all possible, be resolved within the Chippewa County-Montevideo Hospital and Medical Clinic.

Any complaints may be given verbally or in writing to the Director of Nurses or to the Administrator during the hours of 8 a.m. to 5 p.m. Monday through Friday. Also, you may file a complaint verbally or in writing with the office of Health Facility Complaints, 717 Delaware Street SE, Minneapolis, MN.

In the issuance of a complaint or grievance, you do have the right to receive a written response.

A patient satisfaction survey is randomly sent out to patients who have recently received services at the hospital. This survey is compared to results of peer hospitals.

Purpose: The purpose of this policy is to assure each patient's right to decide his or her own treatment. This includes the right to accept or refuse procedures and treatments and the right to make advance directives and organ donations.

Policy: It is the policy of Chippewa County-Montevideo Hospital and Medical Clinic to respect and to encourage patient self-determination. Implementation of this policy will make it possible for patients to be active participants in decision-making about their care through education and inquiry. We hope that such efforts will encourage patients to communicate their preferences and values regarding their medical care to loved ones. We believe that such communication will guide surrogates in medical decision-making for patients who lose their decision-making capacity.

Chippewa County-Montevideo Hospital and Medical Clinic will not discriminate against nor require any condition for care based on whether the patient has executed and advanced directive.

For complaints about advanced directives or questions call The Office of Health Facility Complaints at 612-643-2520 or 1-800-369-7994. Hours are 8:00 a.m. to 4:30 p.m. Monday through Friday.

Our staff is available to provide you with more information, and assist you to better serve your needs.

For more information, contact:
_________________________
Discharge Planner

A modern pharmacy staffed by a licensed pharmacist is available to dispense any medications or drugs required by patients. Medications are dispensed by the dose system so patients receive the proper amount of medication directly from its own container.

Medications that a patient has brought from home must be prescribed by the physician and approved by the pharmacy.

Call Button: If you want to get out of bed, please push your call button and ask for assistance. When you have been lying in bed for some time you may naturally lose your strength temporarily. You can prevent the possibility of serious injury by having someone help you.

Television: All rooms are equipped with color cable television that can be operated from your bed. The volume control, speaker and channel selector are all located on the pillow speaker. Patients may choose from regular cable programming or the hospital's closed circuit educational programming on Channel 5.

Mail: Mail is delivered to patients around noon daily except Sunday. Outgoing mail is picked up daily by the postal service. Just give your outgoing mail to your nurse.

Flowers: Flowers and other gifts are delivered directly to all rooms.

Telephone Service: All patient rooms have telephones. To make local outside calls, dial 8, wait for the dial tone and place your call. To make long distance calls, dial 8-0 and the number you are calling. You will then be instructed by the operator as to how to bill your call. Friends and relatives may call you directly by dialing (320) 269-8877 and the room number at the prompt.

Chippewa County-Montevideo Hospital and Medical Clinic can assist in coordinating resources that enhance communication, hearing and ambulation. If you have special hearing needs, please tell your nurse.

Patients on the road to recovery, but not yet ready to return home, or are preparing to enter a nursing home may be interested in Chippewa County-Montevideo Hospital's Swing-Bed Program. Swing-beds provide a high level of medical and around-the-clock nursing care services for the patient who no longer requires the specialized acute care of the hospital at a savings. There are two types of care available, respite care when the patient requires custodial, maintenance types of care, and a skilled care for those in need of daily skilled nursing service.

A social activities program may be prescribed for the patient. This includes hair care, discussion group and church attendance. Your discharge planner can answer more questions about this program.

Please do not bring valuables of more than $5 in cash with you when you are admitted. Chippewa County-Montevideo Hospital cannot be responsible for personal belongings taken into your room. If you arrive in a hurry or have brought a large amount of cash or valuables, please send them home with a relative or friend or have them placed in our vault. Valuables that have been placed in the vault can be picked up at discharge.

Visiting hours for most patients are 11 a.m. to 9 p.m.

In the Intensive Care Center, immediate family members are allowed only for a specified amount of time at certain intervals.

Visitors can play a very positive role in helping patients recover. Visitors are welcome, but we do ask that they observe the following policies to ensure that all our patients are provided with adequate rest and protection.

Visit frequently, but for short periods of time; visits of not more than 20 minutes are less tiring for the patient.

Only two visitors at one time, please.

Smoking is not allowed in the hospital.

Bathroom facilities in the patient's room are for the patient's use only. Public bathrooms are available in the front corridor.

Overnight visits are allowed for the immediate family of a patient who is critically ill. Permission to stay overnight with a patient must be obtained from the nursing supervisor.

No visitors are permitted in the operating, post-anesthesia or delivery rooms.

Children of any age may visit patients at the Chippewa County-Montevideo Hospital. Children must be accompanied by an adult and be supervised at all times.

Parking for visitors is available adjacent to the hospital.

A registered dietitian and food service supervisor refer to your physician's orders as they plan and supervise your nutritional care. Guest trays for relatives may be ordered by the charge nurse if your family member is critically ill or your child is unable to stay alone. A charge is made for this service. Vending machines for pop, candy and coffee are located at the entrance of the hospital. There is also a public cafeteria located at Luther Haven, which is connected to the hospital.

Meals will be served at the following hours except when tests or other treatment procedures conflict:

Breakfast: 7:30 AM, Dinner: 11:30 AM, Supper: 5:20 PM

Coffee, fruit juices, mild and a variety of other nourishing between meal snacks are always available at the nursing station if your diet permits.

Food cannot be brought from home without permission from your nurse or the dietitian.

If you need to maintain a special diet when you go home, you will receive a nutritional plan which follows your physician's guidelines.