Patient financial information

A: An EOB is a statement sent from a patient’s health insurance provider to the patient that lists services billed and how they were processed. The document lists deductibles, co-insurance, the amount insurance may have paid and the amount due by the patient.

A: Deductible. This is a provision that requires 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% to 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 (doctors/hospitals) at the time covered services are performed. The level of co-pay is determined by the insurance benefit option.

A: A preferred provider organization (PPO) is composed of physicians, hospitals, healthcare providers and clinics that sign contracts with PPO systems to provide care to their insured people, agreeing to accept the PPO fee schedule and guidelines.

A: Yes, it is your responsibility to make sure the requirements of your plan have been met. (For example, you may be required to have precertification of a procedure or visit.) Check your insurance policy booklet to ensure that CCH and your physician participate in your healthcare plan.

A: Yes, CCH follows payment guidelines that state: Either patients make the payment in full, or we offer monthly payment options when patients need more than 90 days to pay their accounts.

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.

A: Examples of third-party liability are auto accidents, falling in a parking lot or any other incident in which someone else may be liable for the patient’s medical charges.

A: Medicare has a list of drugs it considers “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 the drugs are given in an outpatient setting, the costs are the responsibility of the patient.

A: CCH uses “guarantor,” or “family,” billing. That means the guarantor will receive one number. This number is located in a box at the top right of a patient’s statement under the box that shows the patient’s name.

However, each time a patient or his or her 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 patients’ statements 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 who was seen.

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 claims. If your insurance company has not paid for your medical services, you will receive a statement for these services. If this happens, you should contact CCH’s patient accounts department.

Insurance companies frequently request additional information from patients in order to process their claims. The patient accounts department may ask you to contact your insurance company to resolve any delays in processing claims. Please remember, as a courtesy, CCH’s patient accounts department submits your claims to your insurance company. However, these professional services are rendered to patients and not the insurance company; therefore, you are directly responsible for the cost of your treatment.