Insurance Billing Frequently Asked Questions | UC Health

October 24, 2022

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find answers to your insurance billing questions

You are responsible for providing all insurance information and establishing the proper sequence of primary and secondary coverage (coordination of benefits) at the time of registration. copays must be paid prior to discharge.

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uc health will send a bill to your primary insurance company a few days after your discharge. your insurance is expected to pay the claim within 30 days. After your visit, you should receive an explanation of benefits (EOB) from your insurance company, stating how much the insurance company paid and how much you owe.

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You are responsible for making sure your insurance company pays on time. fulfilling this responsibility may require you to contact your insurance company. your coverage is between you and your insurance company. We’ll help you file your claim, but you must take final responsibility for your account.

Most insurance plans have determined certain services may not be covered, such as preventive visits, immunizations, or elective services. We try to tell you the rules in advance, but we don’t always know if a service is covered. Since there are so many coverage plans available, we recommend that you review your policy and contact your insurance company.

insurance billing – glossary

here are some answers to frequently asked questions about insurance billing for patients treated at uc health centers:

will uc health contact my insurance for precertification or authorization?

It is recommended that you contact your insurance plan or provider directly if you have any questions or concerns about precertification or preauthorization.

I have several health insurance companies. How do I know who to bill?

Coordination of benefits rules apply. contact your provider to help you determine the correct billing order.

ohio department of insurance: consumers

if my insurance doesn’t consider uc health a preferred provider, will my insurance be billed?

uc health bills all insurance companies. If your insurance does not list a UC Health Center as a preferred provider, you may be billed uncovered charges or be responsible for reduced benefits.

Contact your provider to verify your coverage and/or benefits.

what if my insurance company does not authorize or cover the services?

You will be responsible for charges not authorized or covered by your insurance company. it is recommended that you contact the provider who placed the order to discuss whether you would like to receive the service and other possible financing services.

why doesn’t my insurance company cover all services?

Under any plan, there may be services that are not covered because the insurance company may deem them routine or unnecessary. If you disagree with the decision, you should contact your insurance company for more information.

what happens if my insurance coverage changes?

You must bring your current insurance card to your next visit. you should also contact our customer service department to provide updated information.

what should I do if my insurance sends payment directly to me?

Insurance payments for claims submitted directly to you, whether from primary or secondary insurance carriers, must be used to pay outstanding charges to uc health. patients are financially responsible for all outstanding charges. deposit the insurance check and send us a personal check, or send the insurance check as soon as possible.

why do i still owe a balance if my insurance company has been paid?

Depending on your insurance plan, you may be responsible for deductibles, copays, and coinsurance for fees not covered by your insurance company.

what does usual and habitual mean? how does this work?

The usual and client fee schedule is established so that non-contracted providers are reimbursed at a rate comparable to other HMO reimbursements in the same geographic area. patient is responsible for charges in excess of usual and customary fee.

If I get services because of an accident at work, will they send the claim to my employer?

Due to confidentiality, we cannot bill your employer directly. however, we will submit claims directly to your employer’s workers’ compensation carrier. we will need the name, address and claim number. you can take your bill to your employer and work directly with them.

what is the difference between an hmo and a ppo?

hmo stands for health maintenance organization. An HMO is a group that contracts with medical facilities, physicians, employers, and sometimes individual patients to provide health care to a group of people.

ppo stands for preferred provider organization. As a rule, you must select a Primary Care Physician (PCP) who has a contract with the PPO. if you choose a doctor who does not have a contract, you pay more. Like an HMO, you generally pay a small amount known as a copay each time you visit your PCP or health care facility. Unlike an HMO, if you choose to see a doctor who does not have a PPO contract, the plan may pay a percentage of medical bills (out-of-network benefits). however, your cost will likely be higher than if you choose a caregiver who is in the plan’s network.

why did my insurance only pay part of my bill?

Most insurance plans require you to pay a deductible and/or coinsurance. in addition, you could be responsible for non-covered services. contact your insurance company for specific answers to your questions. you may have out-of-pocket costs.

what is a copay?

A copay is a set fee the member pays to providers at the time services are rendered. copays apply to emergency room visits, hospital admissions, office visits, etc. the cost is usually minimal. copayment amounts must be known by the patient before services are rendered.

what is a deductible?

Deductibles are provisions that require the member to accumulate a specified amount of medical bills before benefits are provided. For example, if a member’s policy contains a $500 deductible, the member must accumulate and pay $500 out of pocket before benefits will be paid by the insurance company. once the patient has met their deductible, the insurer usually pays a percentage of the bill. the patient is responsible for the percentage not paid. deductibles are annual, usually beginning in January.

what is coinsurance?

coinsurance is a way to share costs. once you’ve met your deductible, the plan will start paying a percentage of your bills. the remaining amount, known as coinsurance, is the portion owed by the patient.

If I have an hmo policy, can I be billed if they don’t pay?

if you have an hmo policy, you should only be billed for the amount specified in your explanation of benefits (eob) provided by your insurance company. this generally includes copay amounts.