Understanding the insurance systems can be complicated, to help navigate the health system, we are providing the information below to explain our payment collection and billing process, and how insurance providers process a claim. If you have any questions regarding this content, please let us know.
UNDERSTANDING YOUR HEALTH BENEFITS
Your health insurance plan is a contract between you “The Insured,” and the insurance company you’ve selected. It is a binding agreement that you will pay your monthly premium, and your insurance company will pay the agreed-upon portions of medical services. In most cases, insurance companies may not pay for every bill or treatment. It is essential for you to know your coverage, which medical procedures are cover and what additional expenses are your financial responsibility. Please remember that a determination or explanation of benefits is NEVER a guarantee of payment to your doctor.
The deductible refers to the amount of money that you are financially responsible for paying before any benefits from your health insurance can be used. Most insurances have both individual and family deductible amounts. The deductible is an annual amount due when your policy is renewed. Occasionally, some services may be covered without meeting the deductible first.
The insurance company set’s a fee limit for each type of exam, treatment, testing, and surgery. They will pay their portion according to your plan policy and any fee above that amount is your financial responsibility. Common co-insurance splits are 80/20, this means your insurance company will pay 80% (depending on your plan) of the medical expenses, and you are financially responsible for paying the difference.
The co-payment is a fixed amount (generally for doctors visits and prescriptions) that you are required to pay our office at the time of service.
Out of pocket expense may refer to the deductible, co-insurance, and co-payments, it is the cost one would pay out of their own pocket at each. Also, when the term annual out-of-pocket is used, it refers to how much the insured would have to pay for the entire year out of their pocket, excluding monthly premiums.
EXCLUSIONS/ NON COVERED BENEFIT/EXPERIMENTAL TREATMENT OR DRUGS/NON-PRESCRIPTION DRUGS
These exclusions are the services and products your insurance will not cover.
MEDICARE FINANCIAL POLICY
Medicare requires that you pay an annual deductible per the calendar year. We collect any outstanding deductible due on the day that services are rendered unless your secondary/supplemental carrier pays the Medicare Part B deductible. Please make every effort to know your secondary/ additional insurance coverage. We will gather all insurance information primary/secondary/supplemental generally at the first point of contact and will verify your benefits on your behalf. Please be prepared to pay all out of pocket expense at the time of your visit, and as always, we welcome your Alphaeon Credit card for all services, products, co-payment, deductible, or any other out of pocket expense.