Billing FAQs For Patients

**** IMPORTANT BILLING SUMMARY****

An insurance plan/product is your (the patient’s) product. It is not ours. You purchase the insurance to help you pay for your medical expenses. We simply bill your insurance out of courtesy. You alone are responsible to understand what is covered in the insurance product that you purchased. Just like buying a car insurance, you should always know what is and what is not covered. We cannot look this up as we do not have access to this. There are hundreds of insurances and also hundreds of sub-plans inside each insurance. Similar to car insurance. You would not request a windshield replacement unless you knew first hand from your insurance that they would cover it. You need to look this up beforehand. You can provide us the insurance card, we will submit the claim to them but if they don’t cover our services you must understand that you are responsible for the services. We will do anything we can to help clarify and help you understand the components of your insurance but in the end this is your insurance and your obligation to know what your product covers.

WHAT INSURANCES DO YOU TAKE? ARE YOU IN MY NETWORK?

We take most commercial insurances but there are a few plans within those that we do not participate in. Keep in mind that many times we don’t pick them, they pick or don’t pick us so we often don’t have a choice. The exact plans can change at any time so we request that you (the owner of the policy) keep track that we are still in-network. If the network status changes we may not know this and if you continue to request services after losing network status you will still be responsible for coverage.

HOW DO I KNOW IF MENTAL HEALTH OR ADDICTION ISSUES ARE COVERED?

You will have to call your insurance carrier to ask this. We will never be able to reassure you in advance as many times the insurance states that you are covered only to turn around and deny a mental health claim. We will sometimes call insurances to inquire but the final reassurance must come directly from your insurance (your product) to you (the owner). We will be happy to bill the insurance as a courtesy but coverage eligibility remains the insurance owners responsibility.

WHAT WILL MY COPAY BE?

Abbreviated for copayment, a copay is a fixed amount a healthcare beneficiary pays for covered medical services. The amount is usually listed on your insurance card. The remaining balance is covered by the person’s insurance company. Copays for standard doctor visits are typically lower than those for specialists. Since we qualify as both primary care AND as a specialist your copay may vary. You will need to call your insurance to determine what your copay is. Note that copays for emergency room visits tend to be the highest. Copays are ALWAYS collected on the day of service without exception. DISCLAIMER: We will never guarantee the accuracy of any information your insurance provides us. Remember that we are giving you the generic definition of what a copay is. It is your responsibility always to call your own insurance and obtain this information on the product you purchased.

DOES MY PCP NEED TO SEND A REFERRAL FOR ME?

You must check with your insurance if you require a referral to see us. If you already have a primary care doctor you may need to contact them to determine if a referral is needed. You must take care of this before you even schedule an appointment with us. If you need a referral and you schedule an appointment without one you will be responsible for the payment in full. We will not be able to call your PCP to get them to produce a referral in retrospect.

WHAT IS MY DEDUCTIBLE?

A deductible is a fixed amount a patient must pay each year before their health insurance benefits begin to cover any other costs. After meeting a deductible, beneficiaries typically pay coinsurance—a certain percentage of costs—for any services that are covered by the plan. They continue to pay the coinsurance until they meet their out-of-pocket maximum for the year. If your plan has a deductible, you are required to pay this in full at the time of visit until the deductible is met. Awaiting for the insurance to deny payment due to your deductible is no longer needed since we can see the live representation of your deductible. If we can see your deductible balance, expect to pay full for any office visits at the time of the visit.

DISCLAIMER: Remember that we are giving you the generic definition of what a deductible is. It is your responsibility always to call your own insurance and obtain this information on the product you purchased. We will never guarantee the accuracy of any information your insurance provides us.

WHAT IS AN OUT-OF-POCKET-MAXIMUM?

This number—also called the out-of-pocket limit— is the most a health insurance policyholder will pay each year for covered healthcare expenses. (does NOT apply for non-covered services) These limits help policyholders control risk by capping their share of healthcare costs. It also helps insurers control risk by making policyholders responsible for part of their healthcare costs. After the policyholder meets the out-of-pocket maximum, your health insurance company pays 100% of allowed healthcare expenses. This helps the individual avoid major financial problems associated with high healthcare costs in years when they need a lot of treatment. Health insurance premiums (what you pay monthly) don’t count toward the out-of-pocket maximum. Nor do balance billing charges for services you receive from out-of-network providers. Also, costs that aren’t considered covered expenses don’t go toward the out-of-pocket maximum. For example, if the insured pays $2,000 for an elective surgery that isn’t covered, that amount will not count toward the maximum. That means that a policyholder could end up paying more than the out-of-pocket limit in a given year.

DISCLAIMER: Remember that we are giving you the generic definition of what an out-of-pocket maximum is. It is your responsibility always to call your own insurance and obtain this information on the product you purchased. We will never guarantee the accuracy of any information your insurance provides us.

Medical Services Billing

If we are in-network with your insurance company, we will submit the charges directly to your primary insurance. After your insurance(s) complete(s) payment to us you will be responsible for payment of any allowable remaining patient balance. If we can see your deductible live then we will request payment at the time of visit since we will know that the visit will be part of your deductible. Please remember that your insurance is your product and as such we hold patients responsible to know what is or is not covered in the insurance product they purchased. You may call our office manager and make installment payment arrangements to avoid having your account go to the collection agency. If your account is not paid 30 days after the date of service your account will be turned over to our collection agency without further notice from us. After your account has been turned over to our collection agency, you will be responsible for the outstanding balance you have with us as well as any agency fees, legal/attorney fees, and court costs. This could be placed on your credit record and may affect your ability to make any credit purchases.

Self-Pay Patients

If you are self-pay or become self-pay full payment is expected at the time of service.

Other Billing Policies Cancellations / No Shows

If you do not call us to cancel or reschedule at least 24 business hours in advance of your scheduled appointment, this will be considered a “no-show”. A fee of $100.00 will be billed to you, the patient, not the insurance company and this fee is required to be paid prior to scheduling the next appointment. If you schedule an appointment with us online at www.hhfamilymedicine.com you will receive an email reminder. Inside this reminder you can conveniently click “cancel appointment” if greater than 24 business hours. Alternatively you can text us in Hale or call us/leave a message on our machine and we can cancel the appointment for you (if greater than 24 business hours).

Routine Physicals and Preventative Services

It is your responsibility to know the benefits covered by your insurance. Please find out in advance if your insurance will pay for preventative services.

Payment Methods Accepted

For your convenience, we accept VISA, MasterCard, money orders, cash, or personal checks with proper ID.

Insufficient Funds

If your check is returned due to insufficient funds, you will be charged a $100.00 “bounced check” fee by us. You will receive a statement for amounts due in this case. Also, you will not be allowed to pay us by check for any visits following the returned check.

Patients in Collections

Patients with unpaid balances in collections will be officially discharged from the practice and will not be scheduled for appointments unless approved by the billing department. Collections balances must be paid in full.

I hereby assign Heritage Hills Addiction Medicine & Mental Health the right to bill and receive payment from my health insurances and authorize HHFM to release information to them for payment and audit purposes and provide access to my records to the necessary parties to accomplish this task and acknowledge understanding of the above policies and procedures.

You, the patient, are responsible for understanding all obligations on your payment information from your insurance directly. We will not guarantee that information they “tell” us is or will ever be accurate.

There may be rare times that our billing staff may communicate with your insurance out of courtesy but if they give us wrong information re your copay/deductible/coinsurance or any other payment component you will still be responsible for those components regardless of what they may tell us.

We will never give you the final word on what you will owe as that is your insurance and your duty to be fully informed on what your payment obligations will be. Communicating with insurances is a difficult process and often we will get wrong information from your insurance. It is still your insurance product and your obligation to be fully aware of any payment obligations your insurance places on you. If they give you or us wrong or misleading information you will still be obligated to cover the expenses incurred. If you need guarantee for coverage please call your insurance and have them reassure you in writing.

There may be times that your insurance will pay for things like medical issues but not for mental health/addiction issues. Again, it is your obligation to be informed what your insurance covers. Just because we are “in network” does not mean your insurance will cover your mental health issues. We simply bill the insurance out of courtesy. We will always bill the correct codes and while some patients request we bill under a medical code when in fact the reason is mental health we will never bill wrong or misleading codes. All codes are billed properly and it is your responsibility to understand what you signed for coverage under your product.