Patient Financial Services

What is the difference between a co-payment, co-insurance, and deductible?

In most cases, health insurance carriers offer two major types of coverage: HMO plans or traditional plans. HMO plans generally set a fixed dollar amount for office visits, outpatient visits, emergency room visits, and qualifying inpatient stays that the patient is required to pay directly to the provider at the time of service. This is called a co-payment.

Traditional plans and Medicare establish a fixed dollar amount that must be paid by the patient (usually annually) prior to any payment made by the health insurance carrier. This is called a deductible.

A co-insurance is typical with traditional plans and Medicare. The health insurance carrier pays a percentage of the charge and the remaining balance is the responsibility of the patient.

What information is needed to bill my insurance carrier?

The following information is required:

• The name, address, and phone number of your insurance carrier.
• The subscriber’s name on the policy. 
• The identification number, including any prefix and/or suffix.
• The effective date of the policy.

It is very helpful if you show the registration clerk or receptionist your health insurance identification card each time you come in for medical services. You may ask to have this information read back to you to ensure your record is accurate.

Why did it take so long for me to receive a bill?

It is a practice of Premier Health Partners, PC not to bill a patient until we have exhausted all means of obtaining payment from your health insurance carrier. At times, we receive partial payments or denials that we feel are incorrect. Therefore, we must follow the appeal process established by your health insurance carrier to dispute their decision. These processes can result in a delay in billing you for your portion of the bill.

What if I am using my insurance and would like a quote regarding the amount I will have to pay after insurance pays their portion (patient responsibility)?

Please contact your health insurance company directly. They will have access to your specific insurance coverage and will be able to give you the most accurate estimate of what you will be responsible for paying.

General Participation Information

Although Premier Health Partners, PC participates with most insurance companies, we may be excluded or limited in our participation of certain product plans offered by an insurance company. Please contact your insurance company directly to determine if your specific product plan participates with Premier Health Partners, PC.

Please note if you are having a procedure done within a hospital, you should call your insurance company to ensure your plan is also participating with the hospital or you may be responsible for payment.