Insurance and Billing

Pagosa Springs Medical Center Patient Financial Services is here to provide you with an accurate, timely and easy to understand hospital and/or clinic bill. Please click on the topics below for billing and insurance information.

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

PSMC is a participating provider for most insurance plans. PSMC will submit a claim to your insurance company. Claim processing usually takes 30-45 days. Soon after that time you should receive an Explanation of Benefits (EOB) from your insurance company explaining how your claim was processed and if there is any amount that you must pay, usually deductibles, co-payments, and/or co-insurance. You will receive a bill from the hospital once we have received payment from your insurance company.  PSMC extends a prompt-pay discount of 5% on the amount you owe us if paid in full within 30 days of your first statement. Your insurance coverage is between you and your insurance company and it is your responsibility to know what your insurance benefits include.

PSMC has staff available who can speak with you about the possibility of applying for Medicaid. To speak with a financial counselor about applying for Medicaid, please call (970) 585-1405.

Medicare will only pay for services that it determines to be “reasonable and necessary”. If Medicare determines that a particular service, although it would otherwise be covered, is “not reasonable and necessary” under the Medicare program standards, Medicare will deny payment for that service. Prior to the service being provided, you will be asked to sign an Advance Beneficiary Notice (ABN), which identifies services that may not be covered and for which you may be personally responsible.

PSMC participates in the Veterans Community Care Program. All non-emergent services must be prior authorized by the Veterans Choice Program. Emergent and inpatient services require notification to the Veterans Choice Program within 72 hours. This notification will determine if the service is authorized at Pagosa Springs Medical Center or if the Veteran will need to be transferred to the closest Veterans facility. PSMC’s Rural Health Clinic serves as an approved Urgent Care for the Veteran program.We honor all Veterans programs.

If you have been in a motor vehicle accident, please provide the following information:

  • Name and address of auto insurance carrier
  • Adjustor name and phone number
  • Claim number

It is PSMC’s policy to pursue liability insurance as primary payment for services rendered to you. If you have health insurance it will be billed once the auto insurance has been exhausted.

The bill you receive from Pagosa Springs Medical Center will only contain charges for services provided by the hospital, hospital employed physicians and the Clinic.

Physicians not employed by the hospital will bill separately for their services. You may also receive a bill from:

Radiology – Radiology Imaging Associates (303) 643-4500
Opthalmology – Four Corners Eye Clinic (970) 507-4182

A Patient Financial Services Representative is available to assist you with any questions you have concerning your hospital bill.


Patient Financial Services

Hours: Monday-Friday, 8:00 a.m. to 4:30 p.m.
Phone: 970-507-3939
FAX: 970-731-1889

Mailing Address
Pagosa Springs Medical Center
95 S. Pagosa Blvd.
Pagosa Springs, CO  81147