September 16th 2019
Billing & Insurance
Every family wants to know the cost of medical care. Our customer service is organized to help our patients by making the patient’s account and insurance status easy to understand, even if that means we work a little harder in the Billing Office.
Highlighted Steps in the Billing Process
- The Billing Office prepares the patient account for billing to you and to your health insurance plan(s). If you have two or more health insurance plans, it is important that all health plan information is provided to us.
- We communicate with you about the status of your account. Typically, communications occur via mail or phone. Our billing staff is oriented to provide outstanding service and we welcome your questions.
- On behalf of our patients, we interface with health plans and networks beginning at the time of patient registration.
- If your health plan requires referrals for an office visits, please provide this information prior to appointments. It is the member’s responsibility to ensure that valid referrals are on file in advance of visiting the physician/provider.
- If your health plan requires pre-authorization or pre-certification of a service, please alert our office of this requirement. Our staff will generally assist the member by obtaining valid authorizations/pre-certifications for surgeries and other procedures when necessary. It remains the member’s responsibility to ensure valid authorization/pre-certification is on file prior to the service delivery.
- We submit claims and monitor the payors’ responses which may include an assigned payment, notice of patient’s deductible, co-payment and/or co-insurance, or denial of the claim submitted.
- Our billing staff is available to assist patients and families with processing the portion of the account that is the patient responsibility. You may also conveniently pay online.
When Services are provided at a FNAPC Medical Office
- When services are provided at one of the FNAPC office locations, the patient (parent/guarantor) will need to complete a new patient registration, or provide updated information prior to the time of your office visit. In addition, a copy of your current insurance card and photo ID will be obtained. Parents/guardians or the patient if over age 18 years will be provided an online link to the Patient Registration webpage when the first appointment is scheduled.
- The co-payment as listed on your insurance card for a specialist will be taken at time of check- in for the appointment.
- Claims for the services provided will be submitted to participating health insurance plans.
- After your insurance plan processes the claim, a notice from the insurance plan will explain what benefits are applied, and then any additional co-insurance or deductibles may be billed to you. An account statement is mailed to you when a balance is due from the patient/guarantor.
- If your plan requires a referral for the visit, it is the responsibility of the parent/guarantor to make sure that there is a valid referral prior to the visit.
- Follow-up visits can be made at check-out.
When Services are provided at a Hospital (Inpatient Services)
- When services are provided while hospitalized, information regarding insurance is obtained from the hospital record. If you have two insurance plans, it is also important that you provide the hospital with both plans and coordination of benefits have been completed so that authorizations are obtained for both plans and appropriate billing for primary and secondary coverage is handled accurately.
- If there should be a change in your coverage from the initial information provided, please make sure the hospital and all other providers are notified as soon as possible. This will allow the hospital to obtain the necessary authorization for the new plan.
- If services are for your newborn, it is important that you add your baby to insurance as soon as possible.
- Any authorizations for services during the hospital stay are obtained by the hospital. The authorization for the facility will also cover the physician services.
When Services are provided at a Hospital or Outpatient Facility
- When services are provided on an outpatient basis at the hospital, ambulatory surgery center, or other healthcare facility, information regarding insurance is obtained from you. If you have two insurance plans, it is also important that you provide the hospital/facility with both plans and coordination of benefits have been completed so that authorizations are obtained for both plans and appropriate billing for primary and secondary coverage is handled accurately.
- If there should be a change in your coverage from the initial information provided, please make sure the hospital and all other providers are notified as soon as possible. This will allow the hospital/facility to obtain the necessary authorization from the new plan.