Q: Why am I getting my statement so long after I saw the doctor?

A: We do not bill 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. Therefore, we strongly recommend patients understand their respective policies by contacting their insurance provider and checking to make sure certain procedures and services are covered prior to receiving care.

 

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. Generally, our offices provide a written notice (waiver) to patients if a certain procedure will not be covered by their insurance. Patients then sign this waiver acknowledging the service is not covered by their insurance. However, many insurance rules are complex and it is ultimately the patient’s responsibility for knowing what is and is not covered; therefore, they 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. Once you provide us with proof of insurance, we will then file the claim, but the $50 deposit will not be refunded to you until your insurance company pays the claim. If you do not have insurance, you will be asked for the $50 deposit and the balance of the services will be billed to you after the visit.

 

Q: I’m uninsured. How will I pay my bill?

A: We realize the growing uninsured population, and have implemented an “Uninsured Discount Policy” that provides a 40 percent discount on medically necessary office visits. These visits include both procedures and immunizations. An uninsured patient is defined as a patient that does not have health insurance through a federal, state or local government program or through private insurance. If a patient has a high deductible plan, they are not eligible for this discount. Note: The patient has to be in “good standing” with the practice as it relates to balances. In order to receive the discount, payment in full is expected at the time services are rendered.

 

Q: So how does this “uninsured discount” work?

A: The discount is applied to an uninsured patient’s office charges, with the following exceptions:

• If the patient qualifies for one of the “financial assistant programs” and is eligible for discounts under the program.
• Elective services or those not medically necessary are not covered.

Financial Assistance Program Guidelines

These programs are available to assist you if you are unable to pay for medically necessary services. Prior to service, you must complete a financial assistance application (FAA) and supply proof of family income and residency on the application. To qualify for one of these programs, your family income must be below or at 200 percent of the Federal Poverty Guidelines for your family size.

Income Guidelines
1 $10,830
2 $14,570
3 $18,310
4 $22,050
5 $25,790
6 $29,530
Note: If you list your income as $0 please provide information regarding your living situation/means of support.

 

Q: I can’t afford to pay my entire balance all at once. What should I do?

A:We can make payment plan 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. Failure to contact the billing office could result in your account going into collections if we are unable to reach you.

 

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.