Why didn't my insurance pay for my services?
Your insurance carrier will forward an explanation of benefits (EOB) for your review; the form explains the payment or denial reason for the services rendered.
What is an Explanation of Benefits (EOB)?
An EOB is the notice you receive from your insurance company after getting medical services from a doctor or hospital. It tells you what was billed, the payment amount approved by your insurance, the amount paid, and what you have to pay.
Find explanations of this and other billing terminology on our Patient Billing Terms PDF.
What if my insurance information or address has changed?
Please contact your office or Reliance Patient Services to have your insurance information updated for you.
Do I have to submit my bill to my secondary insurance?
If your office or Reliance Patient Services has all of your insurance information, your secondary insurance will be billed on your behalf; if necessary.
What is a co-payment?
Copayments are set amounts you pay when you go to a health care provider. Providers usually collect copayments at the visit. Copayment amounts are listed on your health insurance card. For example, Office Visit Copay = $35.
What is a deductible?
Deductibles are the yearly expenses you pay before your health insurance pays anything. For example, each year you pay the first $1,000 of your health care bills before your health insurance pays anything. Your out-of-pocket cost is based on the total amount that your insurance has allowed for the visit.
What is a coinsurance?
Coinsurance is a percentage of the health care bill that you pay after your deductible has been met. For example, you pay 20% and your insurance company pays 80%. Your out-of-pocket cost is based on the total amount that your insurance has allowed for the visit.
What is a referral?
Approval needed for care beyond that provided by your primary care doctor or hospital. For example, managed care plans usually require referrals from your primary care doctor to see specialists or for special procedures. Administrative referrals require minimal clinical information (i.e., diagnosis) and clinician involvement for the approval process.
Why am I being charged a co-payment for services during my annual check up? My insurance plan doesn't require a co-payment for annual visits.
When you are scheduled for your yearly physical there is no co-payment, however, if the provider addresses additional health issues that you may have, an additional visit code might be billed and your insurance may apply a co-payment to this part of the visit. The front-desk staff do not know at the time of check in what services will be provided during your actual visit, as this is between you and your provider.
If there is a co-payment you will be billed. If you have any questions regarding a bill of this type, please contact your insurance company for further details, as it is the insurance companies' discretion as to what is applied as patient responsibility, such as a co-payment.
When will I receive a bill?
Patients are billed as soon as possible after their appointment or hospital stay. Typically, bills are not sent until all insurance claims have been processed, however patients without insurance receive bills directly. The due date will always be noted on your bill. If you have any questions regarding a bill, be sure to contact your office or our Patient Services line to receive help.
What is reflected in my billing statement?
Your bill may sometimes contain both professional and hospital charges. Those could include services such as the following: medical equipment, technology, medical supplies, lab tests, radiology, hospital rooms as well as time the provider spends during the visit treating you, reading test results, and coordinating care. If you are not sure how your health insurance plan will process claims for your doctor’s site, contact your insurance, your office, or Reliance Patient Services to ask what you'll pay out of pocket.
How can I pay my bill?
There are a few payment options
1. Visit or contact your office to make a payment
2. Pay your bill online using your office patient portal
3. Call 984.212.8293 and press 1 to pay your bill by phone or press 2 for questions regarding your bill.
4. Send a check or money order to your office
What if I cannot pay my entire bill or do not have insurance?
Your office may arrange flexible payment options (payment plans) upon request. In addition, if you have medical bills for which you cannot pay, please visit our Financial Assistance page (Launching Soon) to learn more about options available to you. You can also contact Reliance Patient Services for questions about what to do if you do not have insurance.
What is Reliance Patient Services contact information?
(Please do not include any sensitive information such as credit card information, social security, etc. when emailing)
What are the Reliance Patient Services hours of operation?
Telephone: Monday - Thursday, 8:00am - 5:30pm and Friday, 8:00am - 1:30pm
Email: 24 hours a day; a representative will respond during business hours
The start of your office workflow begins when a patient schedules an appointment with your office and it ends when all encounters all closed and all payments have been received. Errors or mistakes in your workflow can lead to your office receiving delayed payments or no payment at all. Medical Coding & Billing is getting increasingly more complicated and having a proper office workflow ensures that billing errors are reduced, reimbursements from the insurance companies are maximized, and patient responsibilities are collected. Everything must connect In-office to have a successful billing workflow.
We've put together a simple and basic workflow that is super effective! Let's take a look:
Appointments must be scheduled and communicated effectively. Obtaining patient insurance information via phone and reminding them that payment is due at time of service will help alleviate issues at check in.
Once appointments are scheduled, the billing staff or billing company should keep watch and contact patients' insurances before their arrival to determine their coverage and costs for the appointment. Contact the patient for a reminder appointment if possible, and make them aware of their copay, deductible, or coinsurance. By performing this step, the patient will be more inclined to arrive prepared to pay for their service without conflict. Always document to make everyone in office aware of patient coverage and communications.
3. Front Desk & Check-In
Front Desk should be aware and prepared to collect patient responsibility upfront. This can be a challenging task, but to make things easier always, let the patient know of any bill or balance at the time of their arrival. ALWAYS COLLECT! If the patient states they are not able to pay the full amount, collect half and ask them when we can expect payment for the remaining balance. Always add a note to their chart so the billing staff or billing company will be aware.
Document, document, document! The provider must be aware of the basic guidelines for each insurance . Proper documentation is key when seeing your patient. Be sure to review Medicare E/M ’95 & ’97 for office visit documentation directions. When you are not sure, always ask your billing staff or billing company for clarification.
Be sure the patient stops at check-out every single visit. This is commonly referred to as a “double check” system. In case check-In misses something, check-out will be able to catch and resolve any issues. Check-out should also schedule the patient for their next appointment and if necessary, check for any balances that may need collected. This is imperative, if the provider performed additional testing that may affect a high-deductible patient. Always double check so the patient is aware of their costs.
6. Coding & Billing
The coding/billing staff or billing company should be responsible for triple checking and coding/creating claims. There should be a thorough check of the provider’s documentation to ensure it correlates with the claims being submitted to the insurance company. The billing staff or billing company should check for patient balances and if something is missed, contact the patient to make them aware of their balance. The billing staff or billing company should audit all documentation and coding once every 3-6 months depending on size of office.
Humana Military & TRICARE 2018 Update
To bring in the new year, TRICARE Select replaced TRICARE Standard and TRICARE Extra on January 1, 2018. TRICARE Standard and Extra beneficiaries will be enrolled in a TRICARE Select plan and TRICARE Prime plan enrollees will remain in their TRICARE Prime plan.
This change will be applied to the TRICARE East Region, which includes Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island Arsenal area only), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area only), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (excluding the El Paso area), Vermont, Virginia, West Virginia and Wisconsin.
Things to Know...
Other Health Insurance (OHI) Reminder:
TRICARE is the secondary payer to all health benefits and insurance plans, apart from Medicaid, Indian Health Services and other public programs identified by the government. Always check for OHI and status of OHI with the patient at each visit.
“Welcome to TRICARE East.” Military Healthcare for the TRICARE East Region | Humana Military, Department of Defense, www.humanamilitary.com/.
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