Frequenty Asked Questions


 

 
  1. I have Medicare and a second insurance. Why did I get a bill?
  2. I have met my deductible. Why am I being asked to pay?
  3. My insurance is an HMO. Why did I get a bill?
  4. I paid my co-payment in the office. Why am I getting a statement?
  5. Why wasn’t my insurance billed?
  6. I don’t understand your statement. Can you explain it?
  7. What type of payments do you accept?
  8. Can I make a payment by telephone?
  9. One of my services was not covered by my insurance. Can you bill something else that is covered?
  10. My insurance says your services were “out of network”. Why?
  11. I was seeing my primary doctor; why am I being billed for a higher co-payment?
 
 

1    I have Medicare and a second insurance. Why did I get a bill?

Some second insurance plans do not cover co-payments; others do not cover your Medicare deductible.

2    I have met my deductible. Why am I being asked to pay?

When your insurance statement says a charge has been “applied to your deductible” or that your “deductible has been met” this means your insurance plan has acknowledged them as applicable towards your deductible.

You are responsible for paying the deductible amount; from that point your insurance will start making payments. Here is an example. If your annual deductible is $150 and our services total $200, your insurance may apply $150 of the $200 charges to your deductible. This means you pay $150 and the insurance plan pays the remaining $50 plus any additional charges you have during the calendar year.

3    My insurance is an HMO. Why did I get a bill?

There are several reasons you may have received a bill: You didn’t pay your co-payment during your last appointment, you had services that your HMO did not cover, we billed your insurance but they told us that your plan is not responsible for the services.

We may have you in our system as a patient with a PPO plan. Unfortunately, insurance cards are becoming unclear about what kind of plan you may belong to. This can lead to our office misclassifying you in our system. If you believe this is the case, please contact our billing office at 626.304.0781 and we will make and necessary corrections.

4    I paid my co-payment in the office. Why am I getting a statement?

If the office was busy when you made your payment it may not have been recorded properly. Make sure you get a receipt for your co-payment every time, especially if you’re making a payment in cash. If we do send you a statement in error, send it back to us with a copy of your receipt or cancelled check so we may properly credit your account. 

5    Why wasn’t my insurance billed?

We bill your insurance with the information you provided to us. If that information is incorrect or out of date, your insurance plan will reject the claim. If that happens we will send you a statement or call you to resolve the problem. To help prevent rejected claims, please bring your insurance card to each visit and confirm your address and phone number.

6    I don’t understand your statement. Can you explain it?

Your statement shows information about your visit(s) including the amount of the charges, payments and adjustments from your insurance plan, and payments you have made. If you need an extra copy of your statement or have any questions please contact our billing office and 626.304.0781 and we will be happy to assist you.

7    What types of payments do you accept?

We accept cash, checks, Visa, MasterCard, American Express, and Discover.

8    Can I make a payment by telephone?

Yes. Contact our billing office at 626.304.0781. There is no additional charge to pay by telephone.

9    One of my services was not covered by my insurance. Can you bill something else that is covered?

No. That is insurance fraud. Our practice selects procedure codes based upon criteria outlined in the Current Procedural Terminology (CPT) guidelines. This is a nationally accepted standard for selecting charges.

10  My insurance says your services were “out of network”. Why?

Your physician may not be contracted with your insurance or we may not be contracted with your insurance carrier. If this is the case you will be responsible for the total balance. To prevent these types of problems we suggest you call the customer service number on your insurance card and verify that we are contracted providers with your specific insurance plan.

11  I was seeing my primary doctor; why am I being billed for a higher co-payment?

Unfortunately, some insurance plans cannot differentiate specialists from primary care physicians in a multi-specialty practice and assess a specialist co-payment to all the patients. If you experience this simply call our billing office and they will correct the error.