Dear PM Pediatrics families,
With the new year underway, we would like to share our 2018 Financial Process Update. Designed to enhance your convenience and our operating efficiency, we are pleased to offer the following options to finalize your payment:
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.
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.
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.
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.
If you do not wish pay for your deductible up-front, 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.
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.)
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.
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.
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.
Our billing representatives are happy to speak with you about your account at any time by calling: 516-869-0650, or via email below.