Dear Dr. Christina
PM Pediatrics

2018 Financial Process FAQ

Why is a financial update happening now?

January 1 is the date that most insurance plans “reset” in terms of annual deductibles and the date that many flexible spending account balances for health are refilled. With the changing environment in healthcare, in particular the Affordable Care Act and the increase in High Deductible Health Plans (HDHPs), more responsibility of payment for medical care is being placed on the patient. We decided to revisit our financial procedures to improve our processes to make them more convenient for our patients and more efficient for our business practices.

What is a Deductible and How Does It Affect Me?

An annual deductible is the dollar amount you must pay out of pocket during the year for medical expenses before your insurance coverage begins to pay.

For example, if your policy has a $2,000 deductible, you must pay the first $2,000 of medical expenses before the insurance company begins to pay for any services.

This works just like the deductible for your car insurance or homeowner’s insurance policy.

When does a deductible begin?

Your deductible begins at the start of your plan year. Most plan years begin either January 1 or July 1, but plans can start on any date.

When do I have to pay for services?

Any time you receive medical care, you will be expected to pay in full for your services until your deductible is met. If you have a very large deductible, called a high-deductible insurance plan, you may have to pay out of pocket for most of your primary care services.

How will I know when my deductible has been met?

You can call your insurance company at any time to check on how much of your deductible has been met and some insurance companies have this information available online. Every time you receive medical services, you will receive notification from your insurance company with how much they paid or did not pay if the amount went to your deductible when they send you an Explanation of Benefits (EOB.)

 How will I know how much you are going to charge me?

With many insurance carriers, we can estimate with confidence what the exact charge will be. In addition, you will receive a letter in the mail (or e-mail) from your Insurance carrier that explains how much of your office visit they pay and how much you pay. This is called an Explanation of Benefits (EOB.) This letter tells you exactly, according to your health insurance coverage, how much of your health care bill is your responsibility and how much is the responsibility of your insurance to pay.

Then what?

We receive the same Explanation of Benefits (EOB) that you do. Most insurance companies will send you the EOB prior to us receiving our copy. It arrives about 10-20 days after your appointment has been billed. We look at each EOB carefully and determine what your insurance has determined as patient responsibility. This is the same way we normally determine how much to send you a statement for in the mail.

But wait, I’m nervous about leaving you my credit card.

We do not store your sensitive credit card information in our office. We store it on a secure web portal called Zirmed, Inc. which is HIPAA compliant and completely secure. Office personnel will not have access to your card. For your protection, only the last 4 digits of your card will show in the system.

When do I give you my credit card?

We prefer for you to fill out the Credit Card Agreement and give us your credit card in person. We will swipe your credit card with an encrypted reader that will securely upload your credit card number into the Zirmed, Inc. portal and return the card to you. With the encrypted reader, we will never see all the numbers of your credit card. You can deliver your credit card information over the phone or by mail, but the most secure way is in person through the encrypted reader.

My High-Deductible Health Plan has a Health Savings Account (HSA) Card. Can I keep my HSA card on file?

Yes, you can keep your HSA/Flexible Spending card on file.

What if I need to dispute my bill?

We will always work with you to understand if there has been a mistake. We will refund your credit card if we or if your insurance company has made a billing error. We will only charge the amount that we are instructed to by your insurance carrier, in the EOB they send to us, in the same way that we normally determine how much to send you a bill for in the mail.

What if I don’t want to pay up-front or leave my credit card or flex spending card on file?

If you do not wish to leave a card on file, we will send you a billing statement once we have received your EOB. If payment is not received within 30 days, we will add a $15 late fee and send a second statement. If payment is not received after another 30 days, we will charge an additional $15 late fee. If we receive no response within 30 days of the final letter date, your account will be sent to a collection agency.

What if I have more questions?

Our billing representatives are happy to speak with you about your account at any time by calling: 516-869-0650, or via email below.







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