Schedule Appointment: We will verify your health insurance coverage details.
Pay your share: You may need to pay your co-pay or full-price, if the deductible is not met.
Claims process begins: Doctors are required to file claim to primary insurance within 180 days from visit. Insurance company will verify provider contracted negotiated rate for services rendered, the check members policy for eligibility and benefits. They have 30-days to review the claim and make a payment, deny payment, or put the claim on hold for more information.
Explanation of Benefits: Insurance company will send you an EOB explaining what was covered and cost of services. If all services were not covered, you may need to make payment to your medical providers office.
Secondary Insurance: When our clinic is satisfied with the payments from the primary insurance, it repeats the process with any secondary coverage.
Be aware of these important differences:
1. There is no provider contract, so there are no negotiated rates.
2. If prior authorization is required and not obtained, you may be responsible for entire bill.
3. The doctor is not required to file a claim on behalf of patient. If they don't, you have to file it.
4. Sometimes, claim payments will be send directly to patient and you must pay the doctor bill.
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