BILLING FAQ
Why didn't my insurance pay anything towards my claim?
If your claim has not been denied for any reason, there is generally a deductible associated with your insurance policy.
What is a deductible?
The deductible is the amount of expenses that must be paid out of pocket before an insurer will pay any expenses. For example, if you have a $5000 deductible per year, you must spend $5000 in claims before your insurance starts paying on any remaining claims beyond $5000. The deductible may not apply to all services; please refer to your individual carrier for more information.
What are the adjustments on my bill?
We are in network with a variety of insurance companies that pay various amounts for the same services. In addition, the insurance fee schedules are constantly changing. As a result, we bill a higher percentage rate to your insurance company to encompass all insurance company rates and changes to the fee schedules. The adjustment that you see is your insurance company adjusting our original billed rate to their negotiated fee schedule. The allowed amount on your Explanation of Benefits (“EOB”) is based on the fee schedule set by your insurance company, not by our office. If you have questions about the pricing please call the customer service number on your insurance card. We cannot charge more or less then the allowed amount.
Will my insurance cover my visit as Preventative Care?
The U.S. Preventive Services Task Force does not recommend skin cancer screenings; therefore, these skin exams and screenings are not deemed preventative by insurance companies. Also, the American Medical Association, “AMA” uses different CPT codes for office visits compared to preventive care visits. Nearly all skin exams will be coded and billed as a regular office visit.If you would like further information regarding preventative visits and insurance billing please visit the U.S. Preventive Services Task Force website for more information. Also see the list of preventive services covered by Medicare.
Do I need a referral for an appointment at your office?
Referrals are only required in our office if specified by your insurance company. Please contact your individual plan to determine if your plan requires a primary care referral for a specialist office visit.
Insurance companies KNOWN to have referral requirements:
1. Tricare Prime
2. Humana Medicare HMO
Coordination of Benefits "COB" Frequently Asked Questions
What is Coordination of Benefits?
COB is used by insurance companies to establish the order in which health insurance plans pay claims when more than one plan exists. Sometimes the member has had previous health insurance coverage with another insurance plan/company.
What if I just have one insurance company?
Often insurance companies will require that patients update COB even though they only have coverage with one plan. It is important to do this every time requested by your insurance company otherwise all subsequent healthcare claims will deny and become patient responsibility. Some insurance plans require COB updates as often as every 6 months. It is common to have to update coordination of benefits if you have had any other insurance plan within the past 2 years.
How do I update?
The fastest and easiest way to update COB is to call the customer service phone number on your insurance card. Some insurances send out paperwork to complete but calling them directly will speed up the process. Simply let the customer service representative know that you need to update Coordination of Benefits.
Why do I have to pay a separate lab bill? Didn't I already pay for the visit?
If you had a biopsy during your appointment, our practice will send your specimen to an in-network laboratory to be read by a dermatopathologist. From here, the lab sends the results back to our office for our providers to determine a diagnosis. If you received a bill from the lab, (not an explanation of benefits from your insurance) that indicates these services are out-of-network, please contact the lab on your statement for correction. We cannot accept payment for lab services.
Cleveland Skin Pathology Billing Department 866-518-2153
My question is not listed.
Please call our billing department at (614) 534-1471 to answer any additional questions you have regarding your bill. Please provide your full name, date of birth and account number when referencing a bill.
