Insurance

 

Accepted Insurances

 

 

*Please call your insurance carrier to verify your insurance coverage with our Tax Id: 95-2745028*

 

Insurance and Financial Policies

We are committed to providing you and your family with quality, cost-effective care. We accept most major insurances, including Medicare.

As changes may occur in the plans that we accept, please verify our acceptance at the time you make an appointment. Call (949) 364-1007 for more information. It is very important for you to bring your current insurance card(s) each visit and to inform us if there has been any change in your coverage or in your address.

 

Benefits and Eligibility

Although we will bill your insurance, full payment is the patient’s responsibility. We will make every effort to verify your coverage prior to your appointment, yet we cannot guarantee coverage of services by your insurance company. To determine your insurance benefits and eligibility please contact your insurance carrier directly. Note that you are ultimately responsible for payment for all services that are not covered by your insurance plan. Any patient balance after insurance is normally due within 30 days. We request payment or co-payment for office services at the time they are rendered unless prior arrangements have been made.

 

Self-Pay Patients

If you are a self-pay patient we will work with you to determine an appropriate payment schedule.

 

BILLING PROCESS

It is our goal to assist our patients in understanding the billing process in our office practice.  We understand that it can be quite confusing and we will work to help you understand the elements of the billing events.

If you are having a procedure done in one of our local hospitals or surgery centers, there are many people and facilities involved in the success of your procedure.  You will be billed for all the elements of the procedure.  You may receive up to five or more separate fees/bills for different services.  Below is a list of the potential groups, facilities, or doctors that may bill you.

All bills will be sent to your insurance carrier first.  Any balances that the insurance does not pay will be your responsibility.  If you are not sure what your insurance will cover, please contact your insurance carrier for more information on your covered benefits. 

Hospital or Surgery Center:  This includes the facility fee that the hospital or surgery center charges.  This covers the cost for the facility staff, equipment, and supplies that are used during your procedure.  This bill comes directly from the facility.

Physician Professional Services:  This is the bill for the physician’s services in conducting your procedure and is billed from the physician Office.

Radiology Services:  These fees will be charged for imaging such as X-ray, MRI, or CT scan.  This fee may include two parts:  the handling of any samples and the reading by a radiologist.  This is billed through the radiology department.

Pathology or Laboratory:  These fees will be billed for anything that is sent to a laboratory for testing.  This may include tissue samples, blood tests, or cultures.  This fee includes two parts: the handling of the sample and the reading by a pathologist.  Tissues or specimens removed during a procedure are required by law to be sent/documented by a pathology or laboratory department.

Anesthesia Services:  The services of anesthesiologist are generally required for surgery.  You will be notified if anesthesia is to be used for your procedure.  The anesthesiologist will bill you for professional services provided during your procedure.

 

Explanation of Benefits (EOB)

Total Charges:  This is the total amount each provider has billed to your insurance.

Allowed Amount:  This is the total amount expected to be paid by your insurance and/or the patient combined (Negotiated Amount or Contracted Amount).

Payable Amount:  This is the amount that the primary insurance will pay.

Patient Responsibility:  this is the difference between the payable amount and the allowed amount.  This represents any deductibles, co-payments, or co-insurance that you may be responsible for in the billing process.  If you have a secondary insurance, they may pay for all or part of the patient responsibility depending on your benefits.

It is your responsibility to be aware of your health care benefits and insurance products prior to using your benefits.  If there are questions with regards to your specific insurance plan benefits, please call your Human Resources Department or your Insurance company directly for explanations.

Contacts

If there is an error or questions on your account with regards to billing from our physician office, please do not hesitate to contact our billing office at (949) 457-7900.  Many times a phone call can assist in clearing up any misunderstanding about your charges.