We collect an estimated cost upfront for your visit based on the expected services. It's important to keep in mind that the actual cost of your medical service may vary based on the specific service you receive and your insurance provider's assessment of the claim. Your insurance's response to the claim we submit after your visit determines the final amount you owe. Here's why you might receive a bill even after paying an estimated cost:
In-Network Cost Sharing
- Deductibles: This is the amount you're required to pay each year before your insurance starts covering costs. If you haven't met your deductible, you're responsible for the costs up to that amount.
- Co-Insurance: After your deductible is met, your insurance covers a percentage of the costs, and you pay the remaining part, known as co-insurance. For instance, your insurance might cover 80%, and you pay 20%.
- Co-Payments (Co-pay): These are fixed fees for certain services, like a doctor's visit or lab test, as defined by your insurance plan.
- Out-of-Pocket Maximum: This is the maximum amount you pay during a policy period before your insurance covers 100% of the allowed amount for covered services.
Denials and Non-Covered Services
- Non-Covered Services: If a service you received isn't covered by your insurance, you're responsible for the entire cost.
- Exceeding Plan Limits: Your insurance may have limits on the number of certain types of visits or treatments. Costs for services beyond these limits are typically your responsibility.
- Insurance Denials: Insurance companies may deny claims for various reasons, such as lack of prior authorization or medical coding errors. In such cases, you might need to cover the cost.
- Out-of-Network Services: If you receive services from providers not in your insurance network, the cost may be higher and your insurance may cover less or none of it.
Understanding the Difference Between Estimate and Actual Cost
- Estimates Are Not Final: The upfront cost we collect is an estimate based on typical services we expect you’ll receive. The actual cost can vary depending on the specific services you actually receive and your insurance's assessment of the claim.
- Insurance Assessment: After your visit, we submit a claim to your insurance detailing the services provided. Your insurance reviews this claim and determines the actual amount covered, leading to adjustments in what you owe.
How to Navigate Billing Confusions
- Review Your Insurance Plan: It’s beneficial to understand your insurance coverage, including deductibles, co-pays, and co-insurance.
- Contact Us for Clarifications: If you receive a bill and are unsure why, please reach out to us. We can explain the charges and help you understand the discrepancy between the estimated upfront payment and the final bill.
Discuss With Your Insurance: For specific questions about coverage or denials, contacting your insurance provider can offer clarity.