What is a deductible?
The deductible is the amount of expenses that must be paid out of pocket before an insurer will pay any expenses. For example, if you have a $3,000 deductible per year, you must spend $3,000 in claims before your insurance starts paying on any remaining claims beyond $3,000. The deductible may not apply to all services; please refer to your individual insurance carrier for more information.
Copayment vs. coinsurance
A copay is a set rate you pay for prescriptions, doctor visits, and other types of care. Coinsurance is the percentage of costs you pay after you've met your deductible.
When does a deductible begin?
Your deductible begins at the start of your plan year. Most plan years begin either January 1 or July 1, but plans can start on any date. (The Medicare plan year begins January 1 and the deductible is $233 for 2022.)
What are the adjustments on my bill?
We are in-network with a variety of insurance companies that pay various amounts for the same services. The adjustment that you see is your insurance company adjusting our contracted rates with them. The allowed amount on your Explanation of Benefits (“EOB”) is based on the fee schedule set by your insurance company, not by our office. If you have questions about the pricing, please call the customer service number on your insurance card.
Will insurance cover my visit as preventative care?
Our providers are happy to see you for an exam and consultation. Most insurance plans do not cover routine preventative skin examinations. The U.S. Preventive Services Task Force does not specifically recommend skin cancer screenings; therefore, these skin exams and screenings are not deemed preventative by insurance companies. Nearly all skin exams will be coded and billed as a regular office visit.
The doctor removed a lesion. Why am I being charged for another surgery to repair it? Shouldn’t that be one charge?
There are two parts to this type of procedure – the removal of the lesion and the repair. The type of removal chosen is dependent on several factors such as size, location and whether it’s benign or malignant. The type of repair functions similarly. The procedure is required to be billed in two parts (removal and repair) because each has specific criteria to meet per insurance coding guidelines.
Do I need a referral for an appointment at your office?
Referrals are only required in our office if specified by your insurance company. Please contact your individual plan to determine if your plan requires a primary care referral for a specialist office visit.
Insurance companies KNOWN to have referral requirements:
1. Tricare Prime
2. Humana Medicare HMO
What is a "Good Faith Estimate"?
You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost.
Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.
- You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
- If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email [email protected], or call 1-800-985-3059.
Coordination of Benefits "COB" Frequently Asked Questions
What is Coordination of Benefits?
COB is used by insurance companies to establish the order in which health insurance plans pay claims when more than one plan exists. Sometimes the member has had previous health insurance coverage with another insurance plan/company.
What if I just have one insurance company?
Often insurance companies will require that patients update COB even though they only have coverage with one plan. It is important to do this every time it is requested by your insurance company. Otherwise, all subsequent healthcare claims will deny and become the patient's responsibility. Some insurance plans require COB updates as often as every 6 months. It is common to have to update coordination of benefits if you have had any other insurance plan within the past 2 years.
How do I update?
The fastest and easiest way to update COB is to call the customer service phone number on your insurance card. Some insurances send out paperwork to complete but calling them directly will speed up the process. Simply let the customer service representative know that you need to update Coordination of Benefits.
My question is not listed.
Please contact our billing department at 1-800-434-4111 or [email protected]
In addition, we recommend that you contact your insurance company if you have any questions about the extent of your healthcare coverage and what your out-of-pocket costs might be. If you don’t have insurance coverage, we have flexible financing options available for you. We also accept cash, checks and major credit cards.
For more detailed information about insurance coverage and billing, visit our Office Policies page.