Why does the doctor’s office need my personal and health insurance information to get paid?

The doctor’s office staff uses this information to confirm your coverage, verify eligibility and to send the health insurance company a request for payment of your medical bill. Be sure that you’ve updated your policy and your demographics at every appointment because much of this information may have changed since your last visit.

How is my doctor’s office paid?

You should pay your co-payment at the time of your doctor’s appointment. We will make every effort to seek payment from your health insurance company for the amount owed under your policy. If your insurance determines you owe more than your co-payment, such as a co-insurance or deductible, we will then bill you for the remaining balance.

What is a co-insurance?

Co-insurance is a portion of your bill, sometimes in addition to a copay, that you must pay. Co-insurance is usually a percentage of the total medical bill — for example, 20%. Essentially, if you have a coinsurance you will be splitting the cost of your healthcare with your insurance carrier.

What is a deductible?

A deductible is the amount that you most pay towards your medical treatment before your health insurance company starts to pay. Deductibles vary for each plan, and might be adjusted depending on how many individuals are on your plan – for example, $500 per individual or $1500 per family. In most cases, the deductible starts over at the beginning of each calendar year.

What is a “coordination of benefits” form?

Many health insurance companies require you to fill out a form that tells the company whether you or another family member have other health insurance. Your health insurance company needs this information to work with other insurers to determine which company pays for what service. It is important that you fill out this form and return it to your health insurance company. Otherwise, your medical bills may not get paid or payment may be delayed.

I have recently changed insurance, but do not have a copy of my new card yet. What should I do?

If you have received correspondence from your new insurance company with your individual plan, identification number and copayment amount on it please provide a copy of this letter to the office. If not, please contact your new insurance company directly or your H.R. contact to obtain this information.