*Please note, this is a guide and you should contact your healthcare insurance company directly for specific details of your plan.

 Why did I receive a billing statement for my office visit?

The statement received reflects the outstanding amount after submission to your healthcare insurance company. This amount is based on your plan and determined by your healthcare insurance carrier. These rates are NOT determined by our group.
If you have any questions regarding the outstanding amount, please contact your insurance company FIRST.  This number may be found on back of your healthcare insurance card or healthcare insurance website.

 What is an Explanation of Benefits (EOB)?

An EOB is a document generated from your health insurance carrier describing what costs it will cover for your medical care.  It is generated when your visit is submitted as a claim for the services you received. An Explanation of Benefits is NOT a bill!
 It will show:
  • The cost of the care you received and allowed amounts
  • Any out-of-pocket medical expenses you will likely be responsible for
  • Explaination for adjustments and denials

 Why does it say my deductible wasn’t met?

Your deductible is an annual amount of money that is paid out of pocket for allowed amounts for covered medical care before your health plan begins to pay.  Deductibles can be high or low, depending on the plan you have chosen, and may affect how you pay for health care costs.  Your healthcare insurance company typically won’t pay a percentage of the allowed amounts until your deductible has been met.

 What is the difference between in-network and out-of-network benefits?

In-network: In-network refers to providers or facilities contracted with an insurance company as part of a network of healthcare professionals a person can choose from depending on their plan. They will typically appear when searching on your insurance company’s website.
Out-of-network: Out-of-network refers to providers or facilities outside of an established network of providers contracted with an insurance company to offer patients healthcare at a discounted rate. For urgent care visits, this is typically applicable to those with HMO plans, plans assigned to an Independent Practice Association (IPA), or those who reside out of area or state.  You should review your plan prior to ensure out-of-network benefits are included.

COVID Billing FAQs

 I received a statement for my COVID test, what should I do?

Start by calling the membership number on the back of your card or checking their website (most now have information on their website for who to contact specifically for COVID test reimbursement). Insurance companies typically respond quicker to patient-initiated calls.
Required coverage information may also be found on “Know Your Healthcare Rights” or go to the Department of Managed Health Care website at: https://www.dmhc.ca.gov/.

 My Explanation of Benefits (EOB) says my test wasn’t covered because it was not done by an in-network provider, what does this mean?

Your health plan’s typical rules for out-of-network care do not apply to the coronavirus test, and your insurance carrier is responsible for payment.

 My insurance company said the claim wasn’t submitted properly…is this true?

Our COVID visits are ordered by a licensed health care provider and inclusive of screening, specimen collection and send out to a laboratory for processing with results provided to each individual, adhering to the requirements for coverage. The specimens obtained are sent to a third party laboratory facility for processing who abide by the same standards.

 Still not sure what to do?

If you are unable to reach your insurance carrier or you still have more questions, please email them to billing@coastalfamilyuc.com.