Frequently Asked Billing Questions
- By presenting your most current insurance card, we are able to verify we have entered your information into our system correctly and accurately. This information is also important if we need to refer you to an outside laboratory or hospital for other services.
- Covered services vary from plan to plan. If the primary insurance plan processes the claim and leaves a deductible or coinsurance, the secondary plan may also have a deductible or coinsurance that has to be met before they will pay any additional amounts. It is important for you to know if your plans will coordinate benefits. This will help you know what to expect.
- Most plans have copays, coinsurance or deductibles which will impact the amount you owe. Insurance plans are chosen by you through an insurance agent or through your employer. Because each plan is different, it is important for you to know and understand what your responsibility will be at each visit.
- A preventative or well child visit covers a basic exam, anticipatory guidance regarding normal growth and development, immunizations, lab/vision screenings.
Providers may address additional medical services during the preventative exam as a convenience for the patient and may include:- The evaluation and management of a new concern or illness
- Further evaluation and/or new treatment of an existing condition, even prescription refills.
Guidelines established by the federal government and the medical insurance industry instruct our providers to bill for all services rendered, even if it means billing 2 separate office visits on the same date of service. *
Most insurance plans agree with this standard and will pay for both services but will usually pay the additional service according to your benefits, which means you may owe a copayment, coinsurance or deductible.
We realize these medical expenses may not be expected and we are willing to work out payment arrangements.
When would I be billed 2 separate office visits on the same date of service?
Example 1: You bring your child into the clinic for her 3 year well visit. During the visit you indicate that she has been coughing and pulling her ears. The doctor diagnoses an upper respiratory infection and an ear infection. Treating these 2 issues is separate from a routine well visit. It must be documented by the doctor in the notes and billed accordingly.
Example 2: You bring your teenager in for a sports physical. During the exam, you raise concerns about depression. The doctor spends an additional 30 minutes diagnosing and counseling the patient. Depression is a separate issue from a routine well visit. It must be documented by the doctor in the notes and billed accordingly.
When would I not be billed 2 separate office visits on the same date of service?
Example 1: Anytime there are concerns with milestone delays or anytime there are concerns with growth and development (speech, motor skills, cognition, not growing, head misshapen, etc…), this would be considered part of a normal preventative visit.
Example 2: Child comes in for a 5 year well child visit. Mom is concerned that child has problems falling asleep at night. This would fall under a preventative visit. *If this becomes a chronic problem, additional and separate visits would be required.
*RULE OF THUMB: If there is a unique problem that requires additional time and work and would normally be addressed in a separate visit, you may be billed for both preventative and acute care.
- No, the insurance would view that practice as fraudulent. Federal law requires us to report the exact service performed and the exact reason for performing them. We are committed to obeying these laws and will not “fix” claims for purpose of payment.