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Frequently Asked Questions

If you don’t see your question or answer below, please give us a call and one of our experienced staff members will be happy to help you.

Major health insurance plans are accepted. Medicare, Medicaid, and Aetna are not accepted. Dr. Deb’s Express Medical Care can bill the insurance companies directly. Just bring your primary insurance card, secondary insurance card (if you have one) and the policyholder’s name, date of birth, and social security number.

A deductible is the amount of money you owe for healthcare services your health insurance or plan covers before your health insurance or plan begins to pay.

For example, if your deductible is $1,000 your plan won’t pay anything until you’ve met your $1,000 deductible for covered healthcare services subject to the deductible. The deductible may not apply to all services.

A copayment is a fixed amount you pay for a covered health care service, usually at the time of the service. The amount can vary by the type of covered health care service.

Coinsurance is your share of the costs of a covered health care service, calculated as a % (for example 20%) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe.

For example, if the health insurance of plan’s allowed amount for and office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.

An Explanation of Benefits (EOB) is a form or document that may be sent to you by your insurance company several months after you have had a health care service that was paid by the insurance company. You should get an EOB if you have private health insurance, a health insurance plan by your employer, or Medicare.

Information included in your EOB is as follows:

  • PATIENT: The name of the person who received the service. This may be you or one of your dependents.
  • INSURED ID NUMBER: the identification number assigned to you by your insurance company.
  • CLAIM NUMBER: the number that identifies or refers to the claim that either you or our health provider submitted to the insurance company. Along with your insurance ID number, you will need this claim number if you have any questions for your health plan.
  • PROVIDER: the name of the provider who performed the services for your dependent. This may be the name of the doctor, a laboratory, a hospital, or other health care provider.
  • TYPE OF SERVICE: a code and brief description of the health related service you received from the provider.
  • DATE OF INSURANCE: the beginning and end dates of the health related service you received from your provider.
  • CHARGE (also known as billed charges): the amount your provider billed your insurance company for the service.
  • NOT COVERED AMOUNT: the amount of money your insurance company did not pay your provider. Next to this amount you may see a code that gives the reason a doctor was not paid a certain amount. A description of these codes are usually found at the bottom or the back of your EOB, or in a note attached to it.
  • TOTAL PATIENT COSTS: the amount of money you owe as your share of the boll. This amount depends on your health plans out of the pocket requirements such as an annual deductible, copayments, and coinsurance. Also, you may have received a service that is not covered by your health plan in which case you are responsible to pay the full amount.

Insurance codes are used by your health plan to make decisions about how much you pay your doctor and other healthcare providers. Typically, you will see these codes on your explanation of benefits and medical bills.

If you have codes on your bill and need to know what they are you can go to this website
https://www.findacode.com

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