We work very hard to simplify billing statements so its easy for you to identify the fees for services rendered and billing if applicable to your insurance company. We also do our best to keep you informed of our billing practices by having you review our financial policy each year. Even with these efforts we find parents are often confused and have questions about their statements. Service description and diagnoses codes are regulated by the Centers for Medicare and Medicaid services, and must be used when billing healthcare services. To make matters worse, insurance companies often suggest a change in codes could result in coverage without acknowledging a provider must bill for the services rendered. Separately identifiable services such as vaccines, laboratory tests, and procedures add even more confusion. Routine well visits often include health assessment surveys which add even more confusion. On the back of this newsletter we included some frequently asked billing questions we thought would be helpful.
Please know our Billing Department staff welcome your questions so please don’t hesitate to contact them at (513) 398-3900
for assistance in understanding your bill.
Frequently Asked Billing Questions
FAQ 1: It looks like my insurance company was charged for both a sick and well visit on the same day?
There may be times when a child needs a service that is not part of a checkup on the same day as a well-child visit. If a child is not well or a problem is found during the checkup that needs to be addressed, the doctor may need to provide an additional office visit service (such as a sick visit). This is a different service and is billed to your health plan in addition to the checkup and is reimbursed at a reduced rate. If your health plan requires a co-payment, coinsurance, or a deductible for these non-checkup services, our office will charge you these amounts.
FAQ 2: There are a lot of services billed with my child’s checkup that I don’t understand? It seems like some of these services should be included with the checkup.
Good health care for newborns, infants, children and adolescents includes regular well-child visits (checkups). Checkups focus on preventive services such as physical examinations, screenings, assessments, immunizations, and advice about health and safety. At the ages of 1, 4, 6, 18, 24 months and ages 11 and older, our Providers will use screening tools to help identify developmental disabilities, early onset of maternal postpartum depression, and adolescent anxiety/depression. These screening tools are used to help our Providers maximize the care for your children. At the ages of 9 months to 6 years, your children will receive vision and hearing screens. Your child will also receive preventive laboratory tests such as screening for anemia and high cholesterol.
FAQ 3: Preventive care is covered at 100% by my insurance company, why am I being billed for additional services provided at my child’s checkup?
Health assessment surveys, questionnaires, and screening laboratory tests are included in our preventive care standards to provide care for a healthy outcome for your child and is recommended by the American Academy of Pediatrics (AAP) guidelines. Your insurance company may not acknowledge the same quality outcome standards or the recommendation of the AAP and may not cover all services provided. We do not want you to be surprised by a bill. We bill your health plan and you based on actual services provided. Please feel free to ask about services that may not be paid in full by your health plan on the day of your visit.
FAQ 4: Why was I charged an additional fee for care my child received during regular office hours on Saturday?
Coding guidelines established by the Centers of Medicare and Medicaid Services (CMS) must be followed when billing your insurance company for services rendered. CMS coding standards allow for billing an additional fee for services rendered after before 8:00 am and after 5:00 pm Monday through Friday, and services rendered on Saturday or Sunday. We charge a small fee of $25 to provide these services and many insurance companies will cover the additional expense acknowledging the cost of providing extended office hours. We find our charge is considerably less than the cost of copayments or coinsurance due for Urgent Care Clinics or Emergency Room visits, and we will work with our families to make payment as easy as possible.
FAQ 5: Why was I charged additional service fees for laboratory services and breathing treatments this time and I wasn’t’ charged for this when I brought my child in for the same service last year?
Medical treatments such as breathing treatments and/or minor surgeries such as splinter or foreign body removal my be bundled into the office visit services and are therefore not billed separately. Your insurance benefits may have changed during the year and your current plan does not bundle the services requiring you are billed separately for each identifiable service provided.
FAQ 5: I’ve never been billed for telephone calls or emails before, why am I getting a bill now?
Care coordination is an important part of caring for your child. Our providers may request your child receive care coordinate services. We have dedicated nursing staff who provide non-face to face care to help parents and/or caregivers get appointments with specialists, discuss specialist visits, and update your child’s medical record to reflect the most current treatment being provided. This non-face to face care is provided to ensure children with special healthcare needs are receiving the care they need coordinated across all healthcare providers, and that parents and/or caregivers are getting their questions answered or getting assistance with referral services when needed.
Evidence based medicine studies demonstrate the benefits to improved quality of care and healthier outcomes when care coordination services have been provided. Non-face to face care is provided at a significantly reduced cost and may not be covered by your insurance. Please do not hesitate to discuss care coordination services with your physician or contact our billing department with questions.