We understand that insurance can be a difficult system to navigate. Insurance has many uses, as well as limitations, and we believe that you can best utilize the benefits from your insurance if you have an understanding of what the benefits and limitations there are before you seek access to care.
It is important to understand how insurance billing works and why you may at times see different amounts than what you expect. When we bill insurance, we first verify that you have coverage and find an estimate in the insurance provider portal of what your insurance will pay and what your patient responsibility will be (this is the portion that you are required to pay).
After you have your appointment, we submit a claim to your insurance company. We charge the estimated amount of your patient responsibility (your copay, coinsurance, or payment toward your deductible – more on what these terms mean in part 2 – “Insurance Terminology Explained”).
Claims typically take 2-4 weeks to process, so it may be 30 days or so before we receive a payment from your insurance company and an explanation of what the insurance paid and what you owe. Sometimes, this amount is different from what was estimated. We do not know for sure what your patient responsibility will be until these claims come back. We try very hard to provide you with accurate estimates, but this is not always possible due to the fact that insurance portals have limited information and may not always show us if you have a deductible that applies first, for example.
For that reason, sometimes when we receive claims back, we have to make adjustments to what you as the client owe. You also receive an explanation of benefits (EOB) from your insurance company that details what we charged, what we receive from insurance, and what you owe as your patient responsibility. This is why you may receive an invoice several weeks after your appointment. If you believe this explanation of benefits is inaccurate, you should contact your insurance company to have it resolved.
While we understand it is frustrating to have unexpected charges, we do everything we can on our end to bill accurately and as quickly as possible to avoid these issues. If we ever bill something in error, please bring it to our attention and we will correct it. However, we cannot control the insurance system or what your plan chooses to cover or not cover, and we simply cannot choose to not be paid for the work our providers have done. We have contracts with our insurance companies that require us to collect accurate amounts for patient responsibilities. You also have agreements with your health plan to pay your deductible before your insurance begins paying, and although we recognize it is frustrating and confusing (and it is for us too!), it is ultimately your responsibility to understand your insurance plan and its limitations. We will do our best to help you as much as we are able.
We also need to know if your insurance changes or terminates. Your insurance will not cover services if it is inactive or terminated. We do not receive any notice from your insurance company when your benefits terminate, and we could not possibly keep track of everyone’s coverage for hundreds of patients – it is your responsibility to make sure you are covered and that you communicate changes in coverage to us. If you do not, you may be left with a bill for our services.
Please bear in mind that we are a small, locally owned company and we simply cannot “absorb” the cost of clients choosing to not pay their patient responsibility balances. We do already offer low cost services through a sliding scale for clients who cannot otherwise afford services.