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Medicare and my supplement always pay my bill in full.  Why do I have a balance due?

Medicare will not pay for self-administered drugs given to a patient on an outpatient basis. If you were in the emergency room or were an observation patient you may be required to pay for drugs that Medicare determines as self-administered. Medicare also has medical necessity checks on certain outpatient tests. If Medicare has determined your test to be not medically necessary, you will be required to sign an Advanced Beneficiary Notice prior to the test being performed. The test(s) will then be your responsibility. Normally, if Medicare does not pay for a test your supplement will not pay for it either. 

Why should I contact my insurance company if they do not pay my bill?

We will make every effort to resolve your account with your insurance company. Occasionally, we will be unable to resolve the issue with your carrier and will need your assistance. If your insurance company is questioning the responsibility of another third party payer, usually they will only accept information from the patient or the subscriber.

What is a co-payment?

A co-payment is a set fee you pay to the provider at the time services are rendered. Co-pays usually apply to emergency room and office visits. The costs are usually minimal.

What is a deductible?

A deductible is a set amount that you must pay before your insurance benefits will pay. For example, if a your policy has a $500 deductible, you must pay $500 out of pocket before your insurance carrier will pay benefits. Once you have met your deductible, your insurance carrier will usually pay the remainder at a specified percentage based on your policy agreement. 

What is co-insurance?

Co-insurance is a percentage of your bill. For example, after your deductible has been satisfied, your insurance carrier will usually pay the remainder at a certain percentage, such as 80 percent. The remaining 20 percent will be your responsibility.