HOW HEALTH INSURANCE WORKS
We know that most everything to do with most health insurance is confusing, but we’re here to help! Below is a small, helpful guide to information regarding insurance and it’s use within the Cedar Ridge Family Medicine clinic. If you have any more questions, feel free to contact billing at 435-586-7676.
Years ago, patients had to pay their medical bills at the time of service, and then sent receipts to their insurance companies — because patients are ultimately responsible for the bills. Most physician offices now accept the burden of billing patient insurance companies. Sometimes there are two or more insurance companies involved, and the secondary ones won’t pay until the primary one has paid.
Most insurance companies require that patients pay a minimal amount at the beginning of each visit. For Medicaid this is only $3.00; for other insurance companies it ranges from $5.00 to $50.00. This amount is set by the insurance companies and has to be paid at the time of service.
Most insurance companies have a yearly deductible amount that has to be paid by the patient before the insurance takes over. This amount is often $500, $1000, or more. Every company has different rules regarding what is and isn’t considered a “deductible” amount. When we know your office visit will apply to a deductible we usually collect $50 at the time of service. This is because we know that $50 is the minimum amount your insurance will apply to your deductible. If they apply more than $50 we will send you a bill for the rest.
Our billers go through many steps to make sure patient claims are paid as soon as possible, so that final bills to our patients can go out as soon as possible after their visit. Most insurance companies pay within about 30 days.
Because our clinic does not always know your deductible amount, and whether other offices are also submitting claims, we cannot know exactly how much the patient will end up owing until all of the insurance companies have settled and have submitted their EOBs (Explanation of Benefits.) Patient statements are sent out as soon as possible upon receipt of EOBs, but generally this will be 30-60 days after your actual visit.