Why do I have a balance or owe money?

While each insurance plan differs slightly, many insurance plans are subject to deductibles and copays. Some insurances also have a coinsurance. The deductible is the amount of money you must pay out of pocket BEFORE your insurance starts to pay for services. Your copay is the amount you pay to the office regardless of your deductible. This means, even once your full deductible is met for the year, you will still be required to pay your copay amount. When we verify the eligibility of your individual plan, we also verify the amount of your deductible. If it is determined that you have a deductible, we will collect a minimum payment at the time of your appointment. This is payment for the services rendered, as your insurance will NOT pay for the visit until your deductible is met. Deductibles vary by plan and reset at the beginning of each new year.

"Why didn't my last provider ask for payment upfront?"

• Some offices may choose to defer collection of your deductible until after the services are provided and billed to the insurance. However, this leads to patients receiving a bill 1-2 months after services are rendered for the full amount of the visit instead of the remaining balance less the amount previously paid towards the deductible. Unfortunately, this frequently leads to patients failing to ever pay as services have already been rendered, which means the provider never gets paid for the visit.
• Certain types of visits are covered without regard to your deductible. For example, annual pap smears (cervical cancer screening) are typically covered at 100% and are not usually subject to deductible or copay because they are considered a preventative screening exam. However, if you have any medical concern to address with the provider during the visit (excess bleeding, discharge, odor, etc.), then this is NOT considered a preventative visit by your insurance as there are additional examinations and tests that may be necessary and therefore, you may be subject to your copay/deductible, if applicable to your plan.
• You may had already met your deductible or out of pocket max for the year from other office visits, imaging, laboratory tests, ER/hospital visits, etc.
• You may have had a plan that had higher copays or monthly payments and it did not have a deductible or a small deductible that was quickly met early in the year.
• Covid: There were various laws and regulations that were implemented during the pandemic that waived many medical fees such as copays and deductibles for much of the last 2 years which are no longer in effect.

In short, there are varying reasons why you may have not been asked for payment upfront from other offices. As for our office, as of January 2023, our owner and provider, Katie Bass, APRN, FNP-C has determined that we will no longer defer to billing at a future date as there are too many patients with large outstanding balances failing to pay for services. Our office policy is now to collect payment at the time services are rendered. Payment is to include your regular office copay PLUS any outstanding balance owed from previous encounters. Once your insurance has been billed for services, you will receive a EOB (explanation of benefits) document from your insurance. This will show you exactly what was billed to your insurance, what your insurance paid (if anything) and what you are responsible for paying. Please note, this is not a bill, but it will disclose the amount that you may still owe to our office. You will receive a bill for the remaining balance from our billing service.

A Message from Nurse Practitioner, Katie:

Please note, we are not attempting to collect anything more than what is or will be rightfully owed for the medical services you are receiving from me and my office. While I understand that "you have never had to do that before", this is standard practice for many offices and now the standard for mine.  I have previously been too flexible and not required patients to pay upfront towards uncovered expenses, but instead deferred the collections to billing and this has lead to an abundance of patients with unpaid balances. I can not continue to operate the business without payment for services, therefore, I have instructed my staff to collect your copayment and any unpaid balances at the time I provide your care. Please do not ask my staff for exception or to speak with me about this policy. If you cannot comply with my request for payment of my services at the time of your appointment, I kindly request that you cancel your appointment at least 24 hours in advance so that I can continue to see patients that are willing to pay for services in a timely manner. Thank you for your understanding.

Why do I have an account balance?

If you have been seen at our office prior to 2023, you may have a outstanding or unpaid account balance. Previously, we only collected copays at the time of your visit and then billed your insurance. Your visit may have only been paid in part by your insurance due to various reasons including unmet deductible(s) or coinsuranace. Our previous billing company was not regularly sending account statements to request payment for balances unpaid by your insurance which is rightfully owed to us. You should have received an EOB (explanation of benefits) from your insurance company that outlined the amount billed for services, the discounted or contracted rate for your insurance plan, the amount your plan paid and the amount that you personally owe. We are happy to provide a copy of the EOB directly from your insurance company that outlines what it owed. You may also request this from your insurance company. If you have an outstanding balance, that amount must be made in full before future appointments can be made as it is payment for services that have already been rendered.   

I received a bill from a third party, is this accurate?

If you have received a bill for services from a third party, please the contact the office for review. We are no longer working with our previous billing company and it has been brought to our attention that there are some patients that received statements for services that were billed incorrectly or Out of Network. Katie is personally reviewing all of these statements to ensure accuracy and will make adjustments as necessary.