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1. What is an “EOB” Explanation of Benefits?

2. What does Deductible, Co-insurance and Co-pay mean?

3. What does “PPO” mean?

4. If CCH does not participate in my healthcare plan (non-network), am I responsible for the out-of-network charges?

5. Can I set up a payment plan?

6. I gave you my insurance card before, why do you need it again?

7. What does “third-party liability” mean?

8. What is SAM (self-administered medications)?

9. What do you mean when you ask for the Guarantor number or Account number?

10. Why didn’t insurance pay my bill?

11. If you have questions that have not been addressed, please contact the Patient Accounts Department. patientaccounts@columbushosp.org

1. What is an “EOB” Explanation of Benefits?
A: A statement sent from the Health Insurance to the patient listing services that were billed and how they were processed listing deductibles, co-insurance, amount insurance may have paid and patient due amount.   back to top

2. What does Deductible, Co-insurance and Co-pay mean?
A: Deductible: provisions that require the member (patient) to accumulate a specific amount of medical bills before benefits are provided by the insurance company.

Co-insurance: after deductibles are met, the plan begins paying a percentage (usually between 80%-100%) of covered charges. The remaining amount, called co-insurance, is paid by the member (patient).

Co-pay: a co-pay is usually a fixed fee ($10, $15, $50, etc) the member (patient) pays to providers (Doctor/Hospital) at the time covered services are performed. The level of co-pay is determined by the insurance benefit option.

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3. What does “PPO” mean?
A: Preferred Provider Organization are physicians, hospitals, health care providers and clinics who sign contracts with PPO systems to provide care to its insured people, agreeing to accept the PPO fee schedule and guidelines.   

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4. If CCH does not participate in my healthcare plan (non-network), am I responsible for the out-of-network charges?
A: Yes, it is your responsibility to make sure the requirements of your plan have been met. (example is pre-certification of a procedure or visit) Check your policy booklet to ensure that CCH and your physician participate in your Health Care plan.   back to top

5. Can I set up a payment plan?
A: Yes, we have payment guideline options we follow:
Payment in full.
Monthly payment options when you need more than 90 days to pay your account.   back to top

6. I gave you my insurance card before, why do you need it again?
A: We request that you bring your “current insurance identification card” each and every time you come to CCH. This will enable us to file your claim properly, as most plans have special requirements and insurances change.   back to top

7. What does “third-party liability” mean?
A: Examples of third-party liability are auto accidents, falling in a parking lot or any other incident where someone else may be liable for the charges.

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8. What is SAM (self-administered medications)?
A: Medicare has a list of drugs they consider “self administered” and these drugs are excluded from coverage in the Medicare program. A drug is considered self-administered when it is self-administered by more than 50% of Medicare beneficiaries on an outpatient basis. This determination is made on a drug by drug basis. When given in an outpatient setting, these drug costs are the responsibility of the patient.   back to top

9. What do you mean when you ask for the Guarantor number or the Account number?
A: CCH does “Guarantor” which is “family” billing. That means the “Guarantor” will receive “one” Guarantor number. This number is located in a box in the top right of your statement under the box that shows your name.

However, each time you or a family member is seen at CCH, a separate “account number” is assigned to each patient. These “account numbers” are located in the body (middle) of your statement with the patient name, date of service and summary of charges. The statement is sent under the “Guarantor” name and this statement will include each separate current “account” number for each patient in the family that was seen.   back to top

10. Why didn’t insurance pay my bill?
A: CCH will file your claim with the information you give at the time of Registration. It is very important that you bring your “new/current” insurance card, Medicare card, and Medicaid card at each and every visit to ensure accurate filing of your claim. If your insurance has not paid, you will receive a statement for your services. Please contact the Patient Accounts Department. Insurance companies often times request additional information from the patient in order to process the claim. We may ask you to contact your insurance company to resolve any delays in processing your claim.

Please remember, as a courtesy, we submit your claims to your insurance company for you. However, our professional services are rendered to you and not the insurance company; therefore, you are directly responsible for the cost of your treatment.   back to top