Can I pay my bill online?

Yes, you may pay online. Click here to fill out the form.

What is the different between an HMO and PPO?

A Health Maintenance Organization (HMO) requires that you only see its doctors and that you get a referral from your primary care physician before you see a specialist. They may have central medical offices or clinics or it may consist of a network of individual practices. Preferred Provider Organizations (PPO) have made arrangements for lower fees with a network of healthcare providers. PPO’s give their policyholders a financial incentive to stay within the network. For example, a visit to an in-network doctor might mean you’d have to pay a $10 co-pay. If you wanted to see an out-of-network doctor, you’d have to pay the entire bill up front and then submit it to your insurance company for an 80 percent reimbursement. In addition, you might have to pay a deductible if you choose to go outside the network, or pay the difference between what the in-network and out-of-network doctors charge.

What is a deductible?

A deductible is a dollar amount set by your plan, such as $250 or $500, that you must pay before your insurance plan will begin reimbursement for your charges. A deductible can be set for either an individual or a family. Deductibles are yearly, usually starting in January.

What is a co-pay?

A co-payment is a type of cost-sharing whereby the member pays a set fee to the provider at the time the services are rendered. The amount is set based on the member’s selected insurance benefits package. Co-pays are applied at the time of service.

What is co-insurance?

Co-insurance is a form of cost-sharing. The co-insurance is the percentage of the total bill that is the patient’s or guarantor’s responsibility. For a bill of $350, your co-insurance might be 20 percent, meaning you would pay $70, while your insurance would pay $280.

What does contractual adjustment mean?

If the service is covered, the contractual adjustment is the difference between the amount that a physician charges and what the contractual agreement is with your insurance company. The doctors often negotiate a fee with insurances and must accept those amounts. The patient is not responsible for this portion of the fee.

What does coordination of benefits mean?

Coordination of benefits (COB) is used to establish the order in which health insurance plans pay claims when a patient has more than one insurance. Your primary insurance is billed first, then your secondary. When health care benefits are coordinated, the insurance companies share the cost without overpaying.

Will my health plan be billed?

If your doctor participates with your insurance, the claim is submitted to the insurance company and reimbursement is sent directly to the provider. Participating with the insurance means that you reassign benefits to the provider, and the provider will accept the allowed amount by the plan. Please be prepared to provide your photo identification and current insurance card(s) during the registration process. It is important to remember that health plan coverage varies and some services are not covered. Co-payment, co-insurance, deductibles, and non-covered services are your responsibility.

When will I get my bill/statement?

We will bill your insurance company(ies) or any responsible third party before sending you a final bill. We do not send patients a copy of the insurance bill. Once these parties have processed your claim, the balance due on this statement is your portion of the bill and is your responsibility to pay at this time. The insurance companies, in general, take 30-60 days to process a bill.

What payment does the practice require before or at the time of service?

Prior to services, the office will request payment for deductibles, co-pays, co-insurance amounts, and non-covered services. The amount of all charges may not be known or available at the time of the visit and it is possible that charges may be added to your bill after services. Therefore, calculated co-insurance amounts are based on estimated charges. Any overpayment will be promptly refunded. Patients with no health plan coverage, patients electing to pay privately, and patients receiving non-covered services are required to pay a deposit.

What will I have to pay if the practice does not participate with my insurance?

Nonparticipation means that you do not assign benefits to the provider, and the provider does not accept a discounted reimbursement. The insurance will reimburse you directly. If you receive services by a provider that is not in network, payment will be expected before or at time of service. The office will provide you with an itemized bill so that you can submit it to your insurance.

Why do I have to pay when I have insurance?

Insurances rarely pay 100 percent of medical services. The benefits, rules, and restrictions are determined by the terms of your policy. Also, if you are covered by a participating insurance plan, we are contractually obligated to collect any co-pay, co-insurance or deductible from you. Prior to your visit, we verify your coverage and the amount you will be responsible to pay at the time of service.

Why didn’t my insurance company pay my bill?

The Explanation of Benefits (EOB) you received from your insurance carrier explains in detail the services that were either paid or denied. If you need further assistance determining the reason(s) why your insurance company did not pay your bill, please contact your carrier directly.

Why did my insurance deny the claim?

These are the most common reasons:

  • The service you received was not covered under your plan
  • You did not provide the correct insurance information at the time of service
  • The service you received was from a physician outside of your plan’s network
  • You were not covered by your plan at the time of service
  • Your primary care physician did not process a referral for the services or the authorization was not obtained prior to the services being rendered

What happens if I overpaid or was overcharged and an extra payment was received by the practice?
If there is an overpayment, all open balances are reviewed. If there is no outstanding patient liability, a refund is processed.

Why am I receiving a refund check?
There was an overpayment to your account. Either you paid too much and/or your insurance paid at a later date and covered some of what you already paid.