Understanding Your Bill

• Your Coordination of benefit – COB may need to be updated with your insurance company. You will need to contact your insurance company to update this.
• When a provider is Not Participating in your plan, the claim may be denied, and the insurance will assess the claim as the patient’s responsibility.
• If your insurance have Changed/Terminated, please provide the updated insurance card to your provider’s office. If your updated insurance is not provided at the time of service, this may result in a claim being billed to an inactive plan which will cause the balance to be the patient’s responsibility.
• Procedure or service is Not Covered by your plan.

• Statements are sent 30 days apart
• Patients may receive reminder notices for unpaid bills via text, email, and/or call. If left unpaid the reminders are made 14 days after the 1st statement, 7 days after the 2nd statement, and 5 days following the 3rd statement.
• Balances left unpaid after completing a 90-day billing cycle are eligible to be sent to collections.

You may receive bills for any of the following reasons.

• Provider visits
• Lab bills
• Visits performed by hospital providers in non-office settings.
• Annual wellness visit (AWV) billed with an office visit.
• Deductibles, coinsurance, and copays established by your insurance company.

• What if I can’t pay my bill?
  • You can call the CBO (Central Billing Offices) at 877-856-3774 or your provider’s office to discuss payment options.
  • You can request a payment plan.
  • You can complete and submit the Financial Hardship Request form.
• How do I get an itemized bill?
  • You can call CBO and request one via portal message.
• Who do I contact to update/rebill my insurance?
  • You can do so on the portal or call the CBO.
• Why am I responsible for paying my deductible and coinsurance?
  • Deductible, copay and/or coinsurance fees are established by each individual payer and are agreed upon in your personal policy.
• What type of payments do we accept?
  • Cash, credit cards and/or check
• Why is it important to check with my insurance plan to verify that my provider is in network with my insurance?
  • To ensure that you have the least amount of out-of-pocket expenses as possible.
• How long before unpaid bills are sent to collections?
  • Patients will receive 3 statements, each 30 days apart.
  • 30 days after the 3^rd statement is sent, the patient will be eligible to be sent to collections.

• ABN (Advance Beneficiary Notice)
  An Advanced Beneficiary Notice (ABN), also known as a waiver of liability, is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service.
• Authorization vs Referral
  An Authorization is a decision by your insurance provider that a health care service, treatment plan, prescription drug or durable medical equipment (DME) is medically necessary. While a Referral is issued by your primary care physician (PCP) for you to see a specialist.
• AWV (Annual Wellness Visit) vs Physical vs OV (Office Visit)
  · An AWV focuses solely on patient answers to a health risk assessment such as height, weight, social habits, etc.
  · A Physical is more extensive than an AWV that includes a full examination by your provider that often includes bloodwork and other tests.
  · An OV, although includes aspects of a physical, if your appointment time is spent on specific health issue(s)/problem(s), we can no longer bill the visit as a physical but instead as a problem-focused “office visit”.
  
• Coinsurance vs Copay
  · Coinsurance is a percentage of your medical bill that you pay after reaching your deductible and before hitting your out-of-pocket maximum. While Copay is generally a set price you pay for doctor’s visits, prescriptions and other types of care. (ie: PCP $25 copay, Specialist $50 copay)
• Contractual Adjustments
  · Contractual Adjustments are the difference between the amount your healthcare provider bills for a service and the amount they are contractually obligated to accept as payment from your insurance provider.
• Coordination of Benefits (COB)
  · Coordination of Benefits (COB) allows insurance providers to determine their respective payment responsibilities, be it as your Primary, Secondary or Tertiary payer.
• CPT (Current Procedural Terminology) Code
  · CPT codes are universal five-digit codes used by all physicians, hospitals and insurance companies to identify the specific care you received.
• Deductible
  A deductible is the amount of money you must pay out of pocket each year before your insurance policy starts paying. These generally occur at the beginning of each calendar year.
• Diagnosis/ICD-10 codes
  ICD-10 (International Classification of Diseases, Tenth Revision) is a system used by physicians to classify and code all diagnoses, symptoms and procedures for claims processing.
• EOB (Explanation of Benefits)
  An EOB (Explanation of Benefits) is a document that explains how your insurance provider processed a claim for services you received. While this document is not a bill, it is an important tool that shows you how your bill is broken down between the medical service provider, your insurance, and you. It can help ensure you are receiving the full benefit or discount that you are entitled to under your insurance plan.
• Financial Policy
  A financial policy lets the patient know what is expected of them and what they can expect from their provider. This will prevent everyone from being surprised about their financial obligations for services rendered.  It also gives providers some legal protection should a patient fail to pay their required portion.
• Hospitalist
  A Hospitalist is a physician who cares for patients while they are in an in-patient setting such as a hospital, rehabilitation facility or skilled nursing facility (SNF).
• In-network vs Out-of-network
  In-network indicates your physician is contracted with your health insurance provider and has pre-negotiated set pricing. While Out-of-network indicates your physician does not have a contract with your health insurance provider and you could be charged full price.
• Medicaid
  Medicaid provides health coverage to low-income people of all ages as well as those with disabilities. It is a government funded plan and is administered by each state according to their individual federal requirements, which determines how much of your treatment cost the program will cover.
• Medicare: Medicare Part A Part B and Medicare Advantage Plans
  Medicare provides health coverage to people who are 65 and older as well as certain younger people with disabilities and those with End-Stage Renal Disease (ESRD). Patients are required to pay for some of their health care through yearly deductibles, premiums and other expenses.
  · Medicare Part A: Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
  · Medicare Part B: Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
  · Medicare Advantage Plans: Other insurance carriers with medical plans approved by Medicare.
• Statement Code and Patient Account #
  If you receive a bill from Millennium Physician Group, it will contain a Statement Code which is specific to that bill and can be utilized to make payments. There is also a Patient Account # which is specific to you and your medical records that can be utilized on the portal as well.