When you give us your insurance information we will verify your coverage and ask your insurance company for your benefits. When we collect your co-pays, co-insurance or deductible it is based on the information your insurance company provided. We can only estimate what your insurance will leave as your responsibility. There are many variables that can effect the amount you may have to pay out of pocket. If we have not collected enough to cover your out of pocket you will receive a bill for the difference.
Our statements will only show dates of service that you have a balance for. If a date of service was processed by your insurance company and you have already paid your patient responsibility you will not see that date of service on your bill.
We try our best to put co-payments toward the dates of service that were indicated, but sometimes the payment is processed before the charge which means the payment you made will go to the oldest balance on your account. If a payment comes and does not have specific dates of service indicated it will also go to the oldest balance first. This is to your advantage as it will take care of the oldest balances and may lower any finance charges that you may incur.
We will bill up to three insurance companies for your dates of service. If your primary insurance has not responded to our filed claims within 90 days we will clear the balance to you so you will receive a bill indicating your insurance is not responding to our requests for payment. After your primary insurance has paid we will attempt to bill your secondary and tertiary policies one time, if we have not received a response within a reasonable amount of time we will clear the balance to you so you can follow up with your insurance company. Billing your insurance is a courtesy we provide to our patients, it is not a requirement.
With hundreds of insurance companies and hundreds of policies under those insurance companies there is no way of knowing every policy and what it will and what it won’t cover. We encourage our patients to know their insurance policy and to find out what is covered and what is not covered under their particular policy. When verifying your benefits we are simply being given your co-pay amounts, co-insurance and deductible and when your policy became effective.
There are a number of reasons why a claim may be denied (your policy was no longer in effect, the insurance company needs information to determine a pre-existing condition or third party liability, your policy has a pre-existing condition clause, plus other reasons). Authorization for a surgery does not guarantee payment of the surgery. You can contact your insurance and they can explain the reason your surgery was denied.
There are a couple of reasons you may have a higher out of pocket cost. We are a Specialist Office, which means some insurance policies charge a higher co-pay for a Specialist than they charge for your Primary Care Physician. Another reason could be that we are out of network with your insurance. There is a difference between accepting your insurance and being a contracted provider on your insurance. You can check with your Insurance Company to see if we are a contracted provider. If you have out-of-network benefits you may be able to see us, but your out-of-pocket costs may be higher. If you do not have out-of-network benefits your insurance may deny payment and you will be responsible for the costs. It is important that you understand your insurance benefits.
Due to the nature of injuries an Orthopaedic Surgeon treats, insurance companies many times require paperwork called subrogation paperwork to be filled out. If your injury was due to a work injury or an accident that may be covered by worker’s compensation, auto insurance, etc. your private insurance may require your claims to be paid by another party. It is important that you fill out these questionnaires as soon as possible and return them to your insurance as you will be billed for these charges until the insurance company processes the questionnaire and reprocesses the claims. Most insurance companies will only accept this paperwork from the patient directly.
Our billing software will generate a collection letter when a patient has been sent two statements without at least 50% of the billed balance being paid. If a payment is not made toward your balance within the last 30 days your account may go to collections. Contact our billing office to make arrangements to help pay your balance.