Statements continue until all payments are made in full. If your insurance plan does not cover the services you received, you are financially responsible for your charges. In most cases, we can help establish a payment plan depending on your balances due. Partial payments made toward your balance will not stop collection activity unless you have made payment arrangements with us. Please call Patient Billing Services to discuss payment options:. Phone: Toll Free: We use a combined billing statement, which means we bill you for both the doctor and the use of the facility and equipment on the same bill.
This allows you to receive one bill and make one payment for both charges. Hours: Monday through Friday, 8 a. Medical professionals assist in your care even though you may not meet them. You have just experienced what's known as "balance-billing," or "extra billing. A balance bill can be a cause for alarm, especially when it is for a large amount of money and a patient isn't expecting it.
Understanding how balance-billing works and when it is allowed and not allowed will help you know what to do if you ever receive an unexpected bill for medical services.
To understand what balance-billing is and how balance-billing works, it's essential to understand what it is not. Balance-billing is not the same thing as charging a patient a deductible, co-insurance or co-pay. The deductible is the amount a patient needs to pay out-of-pocket before a health insurance plan starts to pay for covered services and providers.
For example:. Once a patient has paid the full deductible for the year, they might still have to pay out-of-pocket. Yet they might be responsible for a co-payment. Co-pay amounts vary from policy to policy. Often, plans with lower monthly premiums have higher co-pay amounts. Co-insurance appears similar to a co-payment, but there are a few distinct differences between the two.
Co-pays, deductibles and co-insurance payments are all agreed-upon, shared costs. When a patient signs up for a health insurance plan, they should understand what their co-pay, co-insurance and deductible will be from the beginning.
The amount of the deductible and co-pays or co-insurance compared to the cost of the monthly premium helps patients choose health insurance plans that work with their budget and meet their health care needs. A patient who only sees a doctor for preventative care services might choose a policy with a higher deductible and lower monthly premiums, while someone who needs ongoing medical treatment might opt for a lower deductible and lower co-pays but a higher monthly premium.
While patients can usually anticipate and plan for co-pays, deductibles and co-insurance, they usually can't plan for balance-billing. In many instances, balance-billing comes as a complete surprise to patients. A balance bill is issued when a provider charges a patient with the amount the insurance company doesn't pay.
Unless there is an agreement to not balance bill or state law specifically prohibits the practice which are quite rare , medical providers may bill patients for any amounts not paid by insurance. For example, say a patient has seen a particular dermatologist for years.
Changes to the patient's insurance, or even something as simple as the provider choosing to no longer participate in the network, will mean that the dermatologist is no longer in-network.
Whether or not the insurance plan offers any coverage for the patient's out-of-network visits depends on the policy. Label the pockets or individual folders for the following: Each provider of service your physician, hospital, clinic etc. Prescription information Extra insurance forms Miscellaneous Review statements carefully Make sure you understand the bills and statements you receive.
Read each bill or statement carefully and thoroughly. Review the information looking for: Name of the provider Address of the provider Your account number Date of service and associated charges Description of service Your name, and insurance information including Medicare Phone number to call with questions Explanation of benefits EOB If you have health care insurance, you can expect to receive an explanation of benefits EOB from your insurer.
Next, match the provider statement with the insurance payment statements EOB forms. Clip them together in this order: Place the provider bill on top Then attach the insurance payment statement EOB Lastly, attach the supplemental EOB form, if applicable Proceed with the rest of the provider bills, following the same procedure. Supplemental Insurance If your primary insurance has paid on the claim, then any supplemental insurance you have can be billed.
Keep Track of Payments To keep track of all the payments, make a record of the information on a sheet of paper for easy review. This is found on your statement. Depending on the services, you may have more than one account number. If you have multiple statements with different account numbers each will have to be entered separately to pay them online.
NOTE: If statements are paid separately, you will have multiple transactions on your credit card statement. Please call if you have any questions. The patient's last name. For more information, please call This is still a concern, as ground ambulances are among the medical providers most likely to balance bill patients and least likely to be in-network, and patients typically have no say in what ambulance provider comes to their rescue in an emergency situation.
But other than ground ambulances, patients will no longer be subject to surprise balance bills as of Balance billing in other situations eg, the patient simply chooses to use an out-of-network provider will continue to be allowed. They could lose the contract, face fines, suffer severe penalties, and even face criminal charges in some cases.
Receiving a balance bill is a stressful experience, especially if you weren't expecting it. You've already paid your deductible and coinsurance and then you receive a substantial additional bill—what do you do next? First, you'll want to try to figure out whether the balance bill is legal or not. If the medical provider is in-network with your insurance company, or you have Medicare or Medicaid and your provider accepts that coverage, it's possible that the balance bill was a mistake or, in rare cases, outright fraud.
If you think that the balance bill was an error, contact the medical provider's billing office and ask questions.
Keep a record of what they tell you so that you can appeal to your state's insurance department if necessary. If the medical provider's office clarifies that the balance bill was not an error and that you do indeed owe the money, consider the situation—did you make a mistake and select an out-of-network healthcare provider? Or did you go to an in-network facility and then end unexpectedly up receiving care from a provider who isn't in your insurer's network?
If you went to an in-network facility but ended up inadvertently receiving care from an out-of-network provider who works there, contact your state's insurance department to see if there are any consumer protections in place in your state for situations like that as noted above, federal protections will exist as of If not, you may not be able to avoid the balance bill, but you may still be able to reduce it.
Similarly, if you opted to go to an out-of-network provider, there's not really any way around the fact that you're going to have to pay the balance bill—but you might be able to pay less than you're being billed. If you've received a legitimate balance bill, you can ask the medical office to cut you some slack. They may be willing to agree to a payment plan and not send your bill to collections as long as you continue to make payments.
Or they may be willing to reduce your total bill if you agree to pay a certain amount upfront. Be respectful and polite, but explain that the bill caught you off guard, and if it's causing you significant financial hardship, explain that too. The healthcare provider's office would rather receive at least a portion of the billed amount rather than having to wait while the bill is sent to collections, so the sooner you reach out to them, the better.
You can also negotiate with your insurer. It paid your claim, but at the out-of-network rate. Instead, request a reconsideration. You want your insurance company to reconsider the decision to cover this as out-of-network care , and instead cover it as in-network care. Find contact information for your Department of Insurance by clicking your state on this map.
However, none of them are easy and all require some negotiating. Next, ask your insurer what they consider the reasonable and customary charge for this service to be. Getting an answer to this might be tough, but be persistent. With this information, you can narrow the gap. There are only two ways to do this: Get your provider to charge less or get your insurer to pay more.
If so, get the agreement in writing, including a no-balance-billing clause. Present a convincing argument by pointing out why your case is more complicated, difficult, or time-consuming to treat than the average case the insurer bases its reasonable and customary charge on.
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