What does my payment have to be to keep my account out of collections?
All self pay balances are billed to you in full. You have to pay 33% of your balance
to keep the charges from going to our in-house collection agency. If you cannot
make a payment of at least 33%, you should contact our office when you receive your
statement to set up a budget plan that is affordable to you and sufficient enough
to keep your account from going to collections.
Do you take my insurance?
PNS physicians participate in most PPO plans but you are encouraged to verify if
the physician you would like to see is included on the list of in network providers
for your insurance. If you arrive at the clinic and are unsure, you should inquire
with the staff prior to seeing the physician. If you see a physician that is not
in network with your insurance, you risk reduced benefits or no coverage at all
if you see that physician and you will be held responsible for what your insurance
does not pay.
Who is SBI and why are they contacting me?
SBI (Service Bureau Incorporated), is the outside collection agency that PNS uses
when self pay balances are not paid within an acceptable timeframe and we are unsuccessful
collecting the balance within our in-house collection process. If you receive a
letter or a phone call from SBI, you need to contact them to settle on the account.
If you have specific questions about the charges, you can contact the CBO or the
physician's office you went to.
How can I get a copy of my medical records?
You must sign a release in order for PNS to give you your medical records or to
send them to another physician. You need to contact the physician's office that
you need the records from. They will have you sign the release and give you a copy
of your records. There are no medical records kept at the CBO.
I do not have any insurance, can I still get a discount?
If your account is in good standings your physician can elect to give you a discount.
Contact the CBO and we will contact your physician and see if the physician's office
is able to discount the services.
What is a co-pay?
A co-pay is the money that your insurance requires you to pay for medical services
you receive. Usually there are different co-pays for different services. An example
of a common co-pay is $25 for every physician office visit. Your insurance will
be responsible for the remaining balance of the charge. Some insurance companies
have co-pays on laboratory and x-ray services, prescriptions, procedures, etc. Every
insurance company is different so you should be able to refer to your plan documents
and/or your insurance card to see what your co-pays are for different services.
What is a deductible?
Your insurance company often has a deductible either on particular services, or
on your medical services altogether. A deductible is an amount that your insurance
company has determined that you are responsible for. Once you have met your deductible
your insurance company will kick in and start paying based on your benefits. A deductible
on your car insurance works the same way.
My spouse and I both cover our children under our insurance, which one is responsible
to pay as primary?
To determine which insurance is primary and which insurance is secondary you need
to look at both you and your spouse's birth-dates, (with no regard to the year),
and whichever falls first in the calendar year is primary and the other insurance
is secondary. This is referred to as the birthday rule.
Why am I being billed in full when I gave my insurance information to the physician's
office staff when I was there?
The answer could be as simple as the charge was actually keyed into the computer
system prior to updating the insurance information. This is certainly not intentional
and if you do receive a statement showing you owe the full amount and there is no
notation on the statement letting you know the charges are being denied by your
insurance, you can contact the CBO with your information and we will get it taken
Why when I receive my explanation of benefits from my insurance, does it reflect
a physician I did not see?
Most insurance companies identify a physician by their Tax Identification number.
Since many physicians in a group use the same Tax Identification number, often the
insurance prints the name of the first physician listed in their system associated
with that number. More often than not they have them listed in alphabetical order
so if you see Dr. Stevens and your explanation of benefits reflects Dr. Brown that
is most likely what happened. The insurance also keeps track of the physician you
actually saw, this is only happening when they are choosing who to send the explanation
of benefits to. If you have any concerns however, please contact the CBO and we
will answer any questions you might have.
Why was my claim processed this way?
Claims are processed by your insurance company and PNS follows their instructions
based on your policy. If you believe that your insurance company has processed your
claim incorrectly, please contact your insurance company or contact the CBO if you
have other questions.
Why does my bill show that Medicare applied these charges to my deductible but
my deductible has already been met?
Medicare has a deductible each year of $110. Medicare must have determined that
these charges should be applied to the deductible. You should call Medicare to find
out why they put these charges to your deductible if you think it was in error.
Many times it is because there could be services you had prior to these that you
believe covered your deductible, but for some reason Medicare has not processed
them yet or the physician billed them late. If this is the case, those charges that
haven't been processed yet, when billed, will be paid and not applied to your deductible.
Medicare will not apply more than $110 towards your deductible, however, they may
not process the charges in the same order you expect.
Why does my statement show only Medicare when I have a supplemental insurance
Our statements only reflect your primary insurance. You will see in the detail area
of the statement any transactions that have occurred due to your supplemental insurance
company. If you are being billed and do not see any evidence of your supplemental
insurance processing the claim, please contact our office and we will be more than
happy to verify the insurance we have on file.
Where is the payment I made, it doesn't show on my statement?
Our statements only include open charges. If your payment paid one or more of your
charges in full, those charges and that payment will not appear on the statement
any longer. Only balances still due will show on your statement as well as the payments
associated with them. If you want to verify that your payment was received and has
been posted to your account, you can contact your bank to see if the payment has
cleared or you can contact our office and we will be happy to assist you.