Below are answers to some frequently asked billing questions. To better understand your bill from Alliance Primary Care, click on understanding your billing statement. If you have any questions regarding a bill or payment, our customer service staff would be happy to assist you. Please call our billing office Monday-Friday, 8 a.m. to 4:30 p.m. at 513-585-9009.

Q:  Why am I getting my statement so long after I saw the doctor?
A:  We don’t bill the patients until their insurance has paid (or denied).  It can take considerable time to resolve insurance issues on some claims.

Q:  I have insurance – why am I getting a bill?
A:  If the insurance plan tells us a patient is not eligible, or if we just don’t hear back from the insurance plan at all, then we need the patient’s help in resolving the problem.  Perhaps we entered some information incorrectly, or the patient’s information has changed. Either way, if you receive a bill, just give us a call at 513-585-9009 and we’ll get it straightened out.

Q:  Why didn’t my insurance plan cover this service?
A:  Most insurance plans, even Medicare and Medicaid, have determined certain services that will not be covered, such as preventive visits, immunizations and elective procedures. We try to inform patients of these rules ahead of time, but the rules are complex, and we don’t always know if a service is covered.

Q. If I didn’t know that a particular service I received would not be covered by insurance, do I still have to pay?
A. The Medicare rule states that a patient is responsible for payment “if the patient was informed or reasonably should have known a service was not covered.”  Private insurance plans have similar rules and provide booklets describing what is covered and what is not covered. Patients are responsible for this knowledge, and therefore would still have to pay in most situations.

Q. My insurance company said that if my doctor changed my diagnosis, they would cover the visit. Can the doctor change a diagnosis for this reason?
A.  The diagnosis entered on an insurance claim must be supported by the documented chart note for that visit.  Sometimes a chart note contains information that supports several diagnoses, but the one on the insurance claim is not covered.  In that situation, the chart can be reviewed and another diagnosis, if supported by the documentation, can be submitted.

Q:  I was told at the doctor’s office that if I didn’t have my insurance card with me I would be considered self-pay, and they would require a $50 payment at the time of service.  Why don’t they just use my insurance information that’s already in their computer?
A:  Information changes so rapidly these days, it is vital that we verify accuracy at every visit.  If we are unable to verify coverage, we need a “deposit” before we can extend credit.

Q:  I can’t afford to pay my entire balance all at once.  What should I do?
A:  We can make payment arrangements if you call our customer service team at 513-585-9009.  If you just send in a partial payment without calling us, we will not know to change the status of your account.

Q. If I have a credit balance, why can’t this be applied to any existing balance on my account?
A.  It can be difficult to determine whether a credit balance came from a patient over-payment or an insurance over-payment.  If the insurance overpaid, the credit balance needs to be refunded to them.  If the patient overpaid, the credit balance needs to either be refunded or applied to an “open” balance on their account.  The best thing to do in this situation is to call the experts in the Central Billing Office – we’ll get it straightened out for you.