Clinic billing questions and answers

1. How do I know if my insurance company will cover my visit or certain services?

Coverage varies with each insurance company. So please refer to your insurance member handbook or call your insurance company with questions about what’s covered.

Generally, clinic staff members do not know whether a service will be covered. Your insurance plan may not always cover medically necessary and appropriate services.

2. When do I pay my co-pay?

You should pay your co-pay or co-payment at the time of service. The amount is determined by your insurance plan.

3. What are my payment options?

You can pay in full with cash (at the time of your visit), check, or by credit card (Visa, MasterCard, American Express or Discover).

These programs can help you arrange monthly payments:

4. When will I receive a bill? When am I responsible for my bill?

If you verified your insurance information when you registered, you will not receive a bill until your insurance company has…

• denied the claim
• paid the claim and there is a co-insurance, deductible, or non-covered service for which you are responsible
• not responded to the claim
• determined your coverage is not valid or cannot be verified for the date the services were provided

Payment of your bill is ultimately your responsibility and due upon receipt of your first statement.

5. How does my insurance company know what services I received?

Each service a patient receives during an office visit has an American Medical Association code associated with it.

• CPT (current procedural terminology) codes identify the services performed and the reason they were performed.
• ICD-9 (international classification of diseases) codes specify the diagnosis associated with your visit.

The billing statement for your visit includes these codes. They inform your insurer of the services provided and why they were provided.

6. May I request a change in the coding for a service I received?

Federal law requires appropriate, accurate coding. Coding must reflect what happens during your medical visit and match what is recorded in your medical record.

When denied coverage, people sometimes are told that they would have been reimbursed for a specific procedure if another code had been used. But it's illegal to change codes just to obtain reimbursement. That's why it's important to understand your coverage so that you will not be surprised if a service is not covered.

7. Will the clinic bill my insurance company, worker's compensation or medical liability carrier for my visit?

Yes. To make sure we have the right billing information, we will ask to see your insurance card at every visit. We also will ask you to verify your name, address, Social Security number and employer.

If your claim is for a work-related injury or motor vehicle accident, you will need to provide the necessary information to bill the liability insurer. To comply with government guidelines, we will ask you to sign a form verifying this information.

If insurance information is not available or not provided to us, the account will be billed directly to you.

Please remember that you are ultimately responsible for the charges on your account for treatment you received. Allina Medical Clinic will not become involved in liability disputes.

8. What are preventive services?

Preventive care is important to you and your doctor for your continued good health.

Preventive services or screenings may detect an undiagnosed disease, even if you do not have any signs or symptoms. Preventive services typically happen during an annual or wellness exam. They may include a complete physical exam, immunization advice, routine laboratory tests or X-rays, or guidance on diet, exercise, smoking cessation or other health issues.

9. Are preventive services covered by health insurance?

Coverage for preventive services varies among insurers. To determine your coverage, check your health insurance policy and contact your insurance company with any questions.

10. What if during my wellness exam, my doctor recommends services not covered by my insurance?

We are concerned that you receive the care you need, regardless of insurance coverage.

If your doctor orders tests or services that may not be covered, you may be asked to sign an advance beneficiary notice (ABN). By reading and signing this form, you agree to pay for the service if your insurance company denies coverage.

11. What if my insurance covers my annual exam, but I have a problem I would like my doctor to treat at the same time?

Because your health care is your doctor’s primary concern, your doctor will be happy to address any additional concerns.

If the doctor needs to provide additional treatment or information about your additional concern, you may receive an additional charge. Here’s why: Insurance carriers require accurate reporting from doctors when preventive care and additional problems are addressed during the same visit. So while you may be taking care of two health care concerns at one time, your insurer may see it as taking care of two office visits in one and assess your benefits accordingly.