Why didn’t my insurance pay for my services?
Your insurance carrier will forward an explanation of benefits (EOB) for your review; the form explains the payment or denial reason for the services rendered.
What is an Explanation of Benefits (EOB)?
An EOB is the notice you receive from your insurance company after getting medical services from a doctor or hospital. It tells you what was billed, the payment amount approved by your insurance, the amount paid, and what you have to pay.
Find explanations of this and other billing terminology on our Patient-Billing-Terms.
What if my insurance information or address has changed?
Please contact your office to have your insurance information updated for you.
Do I have to submit my bill to my secondary insurance?
If your office has all of your insurance information, your secondary insurance will be billed on your behalf; if necessary.
What is a co-payment?
Copayments are set amounts you pay when you go to a health care provider. Providers usually collect copayments at the visit. Copayment amounts are listed on your health insurance card. For example, Office Visit Copay = $35.
What is a deductible?
Deductibles are the yearly expenses you pay before your health insurance pays anything. For example, each year you pay the first $1,000 of your health care bills before your health insurance pays anything. Your out-of-pocket cost is based on the total amount that your insurance has allowed for the visit.
What is a coinsurance?
Coinsurance is a percentage of the health care bill that you pay after your deductible has been met. For example, you pay 20% and your insurance company pays 80%. Your out-of-pocket cost is based on the total amount that your insurance has allowed for the visit.
What is a referral?
Approval needed for care beyond that provided by your primary care doctor or hospital. For example, managed care plans usually require referrals from your primary care doctor to see specialists or for special procedures. Administrative referrals require minimal clinical information (i.e., diagnosis) and clinician involvement for the approval process.
Why am I being charged a co-payment for services during my annual check up? My insurance plan doesn’t require a co-payment for annual visits.
When you are scheduled for your yearly physical there is no co-payment, however, if the provider addresses additional health issues that you may have, an additional visit code might be billed and your insurance may apply a co-payment to this part of the visit. The front-desk staff do not know at the time of check in what services will be provided during your actual visit, as this is between you and your provider.
If there is a co-payment you will be billed. If you have any questions regarding a bill of this type, please contact your insurance company for further details, as it is the insurance companies’ discretion as to what is applied as patient responsibility, such as a co-payment.