*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.

How do I get an itemized receipt to submit to my insurance company for reimbursement?

If you would like an itemization of charges of your visit to submit to your insurance company for reimbursement, please email your request to billing@coastalfamilyuc.com. Please note this may take up to 2 weeks after your date of service to allow for your visit to be processed.

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.

Still not sure what to do?

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