Frequently Asked Questions
Billing FAQs: Understanding Insurance, Deductibles, and Copays
Navigating healthcare billing can be confusing, but we’re here to help! Below are answers to some common questions about insurance, deductibles, and copays to ensure you understand your financial responsibilities before your visit.
What types of insurance do you accept?
We accept most major insurance plans, including:
PPOs & HMOs
Medicare & Medicaid
Commercial insurance plans
To confirm coverage, please contact our office or check with your insurance provider.
What is a deductible?
A deductible is the amount you must pay out-of-pocket before your insurance begins to cover costs.
Example: If your deductible is $1,000, you must pay that amount for medical services before insurance starts paying its share.
What is a copay?
A copay is a fixed fee you pay for certain medical services.
Example: Your plan may require a $25 copay for a doctor’s visit.
What is coinsurance?
Coinsurance is the percentage of costs you share with your insurance after meeting your deductible.
Example: If your plan covers 80% of a procedure, and your coinsurance is 20%, you will pay 20% of the total bill while insurance covers the rest.
What does “out-of-pocket maximum” mean?
The out-of-pocket maximum is the most you’ll have to pay for covered services in a year. Once you hit this amount, your insurance covers 100% of approved costs for the rest of the year.
What is an out-of-network (OON) provider?
An out-of-network provider is a doctor or healthcare facility that does not have a contract with your insurance.
Seeing an OON provider may mean higher costs or no coverage at all.
Always check if your provider is in-network to avoid unexpected expenses.
How can I find out if my insurance covers a specific service?
We recommend:
✔ Calling your insurance provider for details on covered services.
✔ Contacting our office, and we can help check your benefits and eligibility.
What happens if my insurance denies a claim?
If your insurance denies a claim, don’t worry—we can help!
✔ We’ll review the reason for denial.
✔ We can assist with the appeal process if needed.
✔ If the service isn’t covered, you may be responsible for the balance.
Do I need prior authorization for certain services?
Some services require prior authorization from your insurance before scheduling. We can check for you and assist in obtaining approval if needed.
What payment options are available if I have a balance?
We offer flexible payment options, including:
💳 Credit/debit cards
🏥 HSA/FSA payments
📆 Payment plans (for qualifying patients)
For details, reach out to our billing department.
How often should I update my insurance information?
To avoid billing issues, update your insurance whenever you:
✔ Change insurance plans
✔ Receive a new insurance card
✔ Experience coverage changes
Still Have Questions?
We’re happy to help! Contact our billing department for assistance.