Billing Questions
Billing Questions
Questions or concerns regarding your account or insurance claim should be directed to our Central Billing Office. These highly trained experts in insurance billing have been instructed to make every effort to clarify any misunderstanding or confusion you may have concerning your account. 931.245.7092
Q: What do I do if my name, address or phone number changes or I have new Insurance?
A: Please contact our scheduling department (931.245.7000) or central billing office (931.245.7092) to make these changes.Q: If I have insurance, do I need to pay anything at time of service?
A: You are required by your insurance plan to pay any co-payment, co-insurance, or deductible that is due at time of service. We are required by our contract with your insurance plan to collect these payments.
Billing Statements
Our statements include charges billed, the payments and adjustments related to those charges. These statements will reflect an amount due from you as well as a balance due from your insurance company. Patients with a personal balance will receive a monthly statement showing the specific amounts due. Patient balances are due upon receipt. Upon receipt of your statement if you are unable to make payment in full please contact our central billing office to make payment arrangements. If you have any questions or concerns please contact our Central Billing Office. 931.245.7092 If the patient is over the age of 18, that patient will be responsible for his or her own account, therefore he/she will receive his/her own statement even if the 18 year old is still covered under parent’s insurance.
Charges
Q: Why am I getting a bill for the services of a doctor I did not see?
A: You probably were seen by a nurse practitioner or physician assistant. The medical claims need to be billed by a practicing physician. Therefore, the supervising doctor would have billed your charges. Also, physicians such as radiologists who interpret or read your tests may have provided services related to your care, even though you didn’t see them. If you had X-rays done at our Imaging Center you may see the Radiologist’s name indicated.
Q: Why does my statement say I am responsible for a charge over the “usual, customary and reasonable” when my insurance company states that I am not responsible for anything?
A: “Usual, customary, and reasonable” are defined by each insurance company and may have little to do with cost of providing care in this area and sometimes are ill defined. If your insurance company is not fully covering the charges for your care from Premier Medical Group and is listing the service as a “non-covered service”, you are considered responsible for those charges.
Health Insurance
If you will be using health insurance to settle your account, you must present your current insurance card at each visit. This is a requirement of your insurance company. It also enables us to have the most current information to bill your insurance company. You are required by your insurance plan to pay any co-payment, co-insurance, or deductible that is due at time of service. We are required by our contract with your insurance plan to collect these payments.Premier Medical Group has agreements with several insurance companies, which require us to bill them for services provided to you, and accept as payment the amount specified in the agreement. You will be responsible for all amounts not paid by them, including amounts denied, applied to deductible, or considered non-covered as permitted by your insurance company.
We will file an initial claim based upon the information that you have provided to us. Under state law, your insurance company has 30 days in which to process and pay the claim, request more information, or deny the claim and notify us of the decision. If they have not notified us within 90 days of the date of service, it will be assumed that your insurance coverage is no longer in force and the unpaid balance will be your responsibility.
If you believe that your claims have been processed incorrectly please contact your insurance carrier and our Central Billing Office to discuss.
Q: How do I know if you accept my Insurance?
A: Please contact the customer service phone number listed on the back of your insurance card. This will ensure the most up to date information.
Click here for a current list of insurance carriers we are participating with here at Premier Medical Group.
Q: Do you file my insurance claims?
A: Premier will file Primary, Secondary, and Tertiary major medical insurance on your behalf if we are a participating provider with your insurance carrier.
PAST DUE ACCOUNTS
Past-due accounts cost both time and money; therefore, patients with delinquent accounts will be required to speak with a Patient Account Representative to make payment and/or payment arrangements.
Seriously past due accounts – those older than 90 days or those failing to honor agreed upon payment terms will be sent to a collection agency. If your account is sent to a collection agency you must pay all collection agency fees, plus any fees associated with the collection of this account. Additionally, patients can be dismissed from our practice for financial matters and will have to seek their health care elsewhere.
Payment for Services
Payment for services provided to you is ultimately your responsibility. For your convenience, we accept cash, check, Visa, Master Card, Discover and American Express. In addition, if you have health insurance, we will gladly file a claim on your behalf.
Self-Pay
All New Self Pay patients will be required to make a deposit of $100 to $150 before being seen by our providers.
If you are self-pay, you will be expected to pay the day’s charges on the day of the service. When you pay at time of service you will be given a discount on eligible services. There may be additional charges for tests and other services rendered subsequent to your visit. You will be billed for these items. If you are having a surgery, you will be expected to make mutually agreeable payment arrangements prior to receiving the service. If the service is considered elective, payment must be made in full prior to the services being performed.
Workers Compensation
Several of our physicians provide services under workers compensation plans. If you need to see a physician for an injury related to your employment, please have your employer or workers compensation case manager make the appointment. You will need to provide us with the case number and date of injury as well as the address to which the bill is to be sent.
Auto Insurance/Third Party Liability
Premier Medical Group does not bill any automobile or third-party insurance. You are responsible for paying the cost of the health care services we provide to you. We will bill you directly and look to you for payment. You will need to settle with your automobile insurance or third party liability carrier separately.