Billing Frequently Asked Questions (FAQs) Provided below is a list of Frequently Asked Questions. For answers to your specific billing questions, please contact our Customer Service Representatives at the facility in which you were seen or call the customer service number listed on your billing statement.
1. Who will bill my insurance?
Mercy Medical Group will first bill the health insurance company on your behalf. If the bill is unpaid because the insurance company states you no longer have health insurance coverage, we will send you a bill. If you have changed insurance companies, contact us as soon as possible so we may change the information on file and bill the account correctly. If your health insurance coverage is through Medi-Cal, an HMO or Worker Compensation, you may not receive a bill. If your bill is denied or your insurance company determines that a portion of the bill is a patient responsibility, you will receive a bill.
2. I visited my doctor's office several weeks ago, why haven't I received a bill?
For patients with health insurance: once your insurance company has been billed and has responded to us, we determine how much you may owe and bill you. Depending on how quickly the insurance company processes the bill, it may take several weeks for you to receive a bill.
3. Why did my billing statement have an adjustment amount?
"Adjustment" (discount) refers to the portion of your bill that your provider has agreed not to charge. Insurance companies pay provider charges at discounted rate. The amount of the discount is specific to each insurance company. When the insurance company pays their portion, the discounted amount (adjustment) is taken off to show the true amount due from the patient (co-insurance). For example, a provider may charge $1,000 for a service hat your insurance has agreed to only pay $250. Of that $250, the patient would have to pay $50 if the patient's responsibility is 20%. After the insurance pays $200 and patient pays $500, the remaining $750 would be the adjustment.
4. I have coverage under both my insurance and my husband's. Since the deductible is less under his insurance, can you bill his insurance and not mine?
Unfortunately, under a provision called coordination of benefits, the provider is required to bill the insurance that would be considered primary for you. Any health insurance for which you are the primary holder must be billed before any other health insurance.
5. When will my insurance company settle my account?
While each insurance company is different, we generally expect full payment from your insurance company within 45 days of billing.
6. How will I know how much I will need to pay?
Once we receive a payment or denial from your insurance company, you will receive a statement showing the amount that is due from you. This amount should be the same amount noted on the Explanation of Benefits (EOB) you receive from your insurance company. This amount is due when you receive the statement. If you have questions, please contact your insurance company or our Customer Service number located on your billing statement. Please note that if your insurance company fails to make any payment on your account, we may ask for full payment from you.
7. How can I make a payment?
Mercy Medical Group accepts cash, VISA, MasterCard and personal checks. If additional methods of payment are required, please contact our Customer Service number located on your billing statement and we will work with you to facilitate timely payment.
8. Where can I find answers to questions about Medicare?
Go to www.medicare.gov
for more information on Medicare.
9. What is an Advance Beneficiary Notice (ABN)?
An Advance Beneficiary Notice (ABN) is a written notice from either the physicians, providers or suppliers, before they provide a service or item to you, notifying you:
- That Medicare may deny payment for the specific service or item
- The reason the physician, provider or supplier expects Medicare to deny the payment
- That you may be personally and fully responsible for payment if Medicare denies payment
An ABN also gives you the opportunity to refuse to receive the service or item.
10. What if I cannot pay or I do not have Insurance? If you need help paying your bill, you may qualify for a government-sponsored program or Dignity Health Payment Assistance Program that may cover some or all of your balance. For more information, please call the customer service number listed on your billing statement.
11. What if I am unable to make the full payment? Can I set up a payment plan? Yes. If you would like to set up a payment plan, please call the customer service number listed on your billing statement.