Insurance and Billing Information

Below is additional information for Rau Family Medicine insurance and billing.

This information has been prepared to answer many common questions that patients have about insurance and billing for our services. Please let us know if we can answer any additional questions to help make the financial side of your experience with us as easy as possible, so you can focus on health and wellness.

Financial Review Services
If you have an insurance plan that is not contracted with us, as a courtesy we will file with your plan. All balances left after plan payment are the responsibility of the patient.

Referrals and Authorizations
Most managed care plans, health maintenance organizations (HMOs), and point of service plans (POS) require that your primary care physician refer you to receive specialty care. Each plan is different, and it is your responsibility to know the requirements for your plan and obtain any necessary referrals. You may be responsible for payment or your appointment may have to be rescheduled if you do not get the necessary approvals.

Many Insurance plans also require prior authorization for services. If your insurance company does not approve your care, we will notify you In advance, and you will be responsible for payment, should you choose to proceed with services.

Patient Out-of-Pocket Financial Requirements
Most Insurance companies require patients to pay a portion of their doctor's visit or hospitalization costs. The patient's responsibility can be described as a co-pay, co-insurance, or deductible. You will be asked to pay your co-pay and co-insurance amounts on the date of service. Failure to pay your portion of the visit may result in a $25 charge being added to your account.

Estimates, Deposits, Discounts and Refunds
Our billing staff is trained to prepare estimates for you if you have a financial responsibility. These are only estimates and may not represent the full scope of charges you actually incur. A 25% discount will be offered when you pay the full balance on the same day of service.

If the deposit turns out being more than your final bill, you will be refunded once the insurance balance has been settled. If there was no insurance involved, we will refund your money once all charges have been totaled.

Payment Options
For your convenience, you may make a payment in a variety of ways:

Cash, check or money order
Visa and Mastercard

Billing
If you have questions about your bill, please call and ask for the billing department.

How do I know if you contract with my health plan?
To receive full insurance benefits, some insurance providers require patients to receive services with “in-network” or “participating provider” hospitals and physicians. Call your insurance provider to check its requirements and to make sure we are in the network.

If you are “out of network,” may I still go there?
Yes. However, you may be required to pay a larger deductible or a greater portion of your bill. Be sure you understand your health plan's “out-of-network” options.

How can I be sure my insurance provider will pay my bills?
Some health plans require certain services to be authorized, or pre-certified, before the patient receives them. Other health plans require the patient to notify them within a certain period of time after services are rendered. Know your health plan's requirements by reading the information given to you by your insurance provider or employer, or by calling your insurance provider directly. You also may call one of our representatives to discuss insurance payment concerns.

Do you send the necessary information and paperwork to insurance providers?
We try to send all the necessary information to insurance providers; however, they sometimes need more information from you to process a claim.

How will I know how much I owe?
Your insurance provider will send you an Explanation of Benefits (EOB) notice that details the amount it has paid, any non-covered or denied amounts, and the remaining balance that you are responsible for paying to us. Review your EOB carefully, compare it to your billing statement, and call your insurance provider or one of our billing representatives right away if you have questions or concerns.

Also, many health plans require patients to pay a co-payment or deductible amount that may be due at the time of registration or discharge from the hospital.

How often will I receive a statement?
Statements are issued monthly. You will receive a statement every month up to 60 days. At 90 days, a first collection letter will be sent and your account is placed on hold.

What if there is a mistake on my statement?
If you have billing questions, call our billing department during normal office hours.

Why does the statement show a total account balance when I have insurance coverage?
Most likely we have not yet been paid by your insurance company. In most cases, your insurance company will make payment as long as the services are covered under your benefit plan. However, if your insurance plan does not cover the services you received, you are financially responsible for them.

What does “Physician Visit Level 3” refer to on my bill?
We use five levels to describe the time and complexity of physician visits, with Level 1 being the lowest and Level 5 being the highest.

What does “adjustment” mean?
“Adjustment” refers to the portion of your bill that your doctor has agreed not to charge you.

Do you bill secondary insurances?
Yes, we are dedicated to helping you receive full benefits from your insurance provider. You will be asked to provide complete insurance information upon registration. Be sure you have a copy of your insurance cards at that time. As a service to you, we will submit secondary claims along with required EOBs to your insurance provider. However, if your insurance provider doesn't make payment within 60 days, we will ask you to pay the amount owed. We will not file tertiary insurance claims.

What if I cannot pay the amount I owe in full?
Call our billing department and inquire about being set up on a payment plan. We will be happy to work with you to set up a mutually agreeable payment plan and to answer your questions. Partial payments made toward your balance will stop collection activity only if you have made payment arrangements with us. Please call us to make arrangements.

May I pay my bill with a credit card?
Yes. For your convenience, we accept cash, personal checks, debit cards or money orders, Visa, and MasterCard. We will charge your credit card only for the amount you authorize. Payment plans also may be arranged through our billing department.

Why was my last payment divided and applied to the bill in two separate places?
We post your payment to the oldest charges first. On your billing statement, we itemize both the charges and your payments by date.

Why did I receive a bill for a doctor I did not see?
Certain physicians help with your medical care even though you may not meet them. Commonly, these are the doctors who read your lab results, X-rays and EKGs, among others. Please call us anytime you have a question about a charge on your bill.

What You Expect From Us
Our Patient Billing Department promises to make the billing process as easy as possible. We want to make sure you receive the full benefits of your insurance coverage as well as consideration under our financial assistance programs, if applicable. Here are some other things you can expect from us:

Billing directly to insurance providers.
Before we bill you, we bill your insurance provider, including Medicare and Medicaid, and any secondary insurance providers. At the same time, we will send you monthly billing statements so you are aware of any insurance activity. The statement will show that the balance is pending with insurance.

Billing statements in plain language.
You will receive easy-to-understand billing statements showing the most current balance owed by your insurance provider as well as any balance due from you.

World-class customer service and financial counseling.
Our billing representatives are happy to answer your billing questions and help with payment issues. Remember, if you have questions, please call us during normal business hours. We're here to help.

How You Can Help

Please give us complete health insurance information when you check in for your appointment.
In addition to insurance cards and authorization forms, we may ask for a driver's license or other identification. It is your responsibility to keep your insurance current in our system.

Please understand and follow the requirements of your health plan.
Be sure to know your benefits, obtain proper authorization for services, submit referral or claim forms, or fill out a coordination of benefits form, if necessary. Also, know that many insurance plans require patients to pay a co-payment or deductible amount that may be due at the time of registration, at the time of service or discharge from the hospital. You are responsible for paying co-payments required by your insurance provider. We are contractually obligated to collect the copay at the time of service. Please come to your appointment prepared to make your co-payment. If a service is designated non-covered, you will be billed the full amount of the charge. This payment is your responsibility.

Please respond promptly to any requests from your insurance provider.
Insurance benefits are the result of your contract with your insurance company. We are a third party to those benefits and may need your help with your insurance. If your insurance provider has not paid us after a reasonable time (usually 60 days after billing) and has not responded to our attempts to resolve payment on your behalf, the amount owed may become your responsibility.

If you have a balance due on a bill, please make timely payments.
It is important you pay “what you owe now” as noted on your billing statement. Do not wait for your insurance company to pay “pending” balances.

Call us if you have any questions or concerns about a bill.
Billing representatives are available during normal business hours.

You have several responsibilities to ensure that the billing process goes smoothly. Those responsibilities include:

When making an appointment and when presenting for your appointment, providing the most recent Insurance cards and making sure that we have the correct address for you,
Understanding your insurance benefits, limitations, and procedures. Contact your insurance company prior to your health visit so you are familiar with its requirements.
Confirming in your Explanation of Benefits that we are a contracted provider of services for your plan.
Obtaining a referral, if required. Discuss this with your primary care physician prior to scheduling an appointment with one of our specialists.
Knowing the limitations of the referral and obtaining an extension or expansion of the scope of the referral if needed.
Being prepared to make payment prior to service if your insurance company requires a co-pay or out-of-pocket expense. Services may be postponed if payment is not made.
All patients are responsible for balances due on their accounts, and payment is due upon receipt of the bill. We employ third-party collection agencies to help us resolve unpaid balances.

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