This is specifically related to Terry Rehabilitation & Testing – Most of the questions fall into the same major categories:
Category #1 – Same or Similar Amount Due 2 Months in a Row
I paid a statement last month, the amount was exactly (or almost) the same amount. Why?
Most of the time this occurs because your insurance policy included a deductible or coinsurance. We submit these claims to the insurance company once per week, and it normally takes 15-40 days to receive payment. When we receive payment, we get an explanation of benefits (EOB) just like you do, that notes how much of the total amount should be applied to deductible or coinsurance.
On your next statement, you will receive an amount due reflecting only the coinsurance/deductible for those visits we received payment for. Depending on the timing of payments and statements, you might then receive two statements in a row for a very similar (possibly the same) amount.
For example, you attended 6 therapy visits, all with a coinsurance of $10. Before your first statement, we received payment for the first three visits, passing along a statement due balance of $30. You pay that amount. Between that and the next statement, we receive payment from your insurance company for the next three visits, each with a coinsurance of $10, and so you receive another statement balance of $30, for the second set of three visits.
Category #2 – Unexpected/Late Copayment, Coinsurance, Deductible
You sent me a bill for a deductible that my insurance company says I don’t owe. Why?
We want to understand your insurance coverage, so that we can most efficiently collect the amount due from each patient. We do not want to issue credits, refund checks, or recoupments. Therefore, we contact each patient’s insurance company to verify the nature and extent of benefits. We want to know specific details regarding coverage limits, amounts, coinsurance, deductibles, copayments, allowances, etc. Therefore, we take the time to verify your insurance coverage information at or just after your first appointment, and send that information to you via mail within a week.
We usually contact your insurance company personally to obtain this information, and record the name of the person we spoke with, the number we called, and the date of the call. Many insurance companies have different coverage details based on the “Place of Service” (POS). The place of service could be a hospital outpatient department, a physician’s office, or the patient’s home. To make matters more complicated, each insurance plan refers to these POS locations differently. To clarify, we utilize only the universal POS code (POS #11) when speaking with insurance companies, who actually already possess detailed information on our clinic.
Despite all the precautions we take, occasionally the insurance company representative simply gives us the wrong information over the phone, or your insurance plan applies the wrong benefits to your visits. In both cases, you will need to contact your insurance company and verify the coverage details. Because each plan is different, we have no way of knowing the details of your specific plan – which you should ordinarily have in a document provided to you by your insurer.
Even though you may be surprised by the amount that you owe, you are responsible for the amount due (unless your insurer alters it) and our company and your insurance company have signed an agreement stating that we will collect that amount from you, and that amount is deducted from our payment. For that reason, we cannot alter the amount, refund it to you, etc, unless we receive something in writing from your insurance company explaining the mistake, correcting the payment(s) and rectifying the situation.
My therapy was 6 months ago! Why are you just now billing me for this?
In most cases, we chose not to charge coinsurance and deductible up front. This is convenient for both of us because it allows you to delay payment and start therapy, while it allows us to ensure that the correct amount is applied to the deductible and coinsurance. The information we receive from your insurance company is many times out of date or other bills will reach them before ours.
Because we invoice these amounts once we receive payment, you will not receive a statement from us until we have received a payment to apply. In some cases, your insurance company may not respond to our invoices in a timely manner. Sometimes, for some visits, they may request written information from us to be mailed to them. Other times they will request information from you, and will not issue a payment until that information is received. Still other times a claim may be “stuck” in processing with your insurance company (for one of these reasons initially, and then erroneously afterward) until we call and request a reprocessing of the charge.
In all cases, your insurance company should have sent you an EOB explaining a denial or delay in payment. We will not send any additional correspondence until we have the amount due, at which time you will receive a statement.
I paid another statement months ago, so I’m sure I don’t owe this “new” amount.
Just as all payments can be denied, in some cases only a few payments are denied. For example, you attend 8 therapy sessions, but for whatever reason, your insurance company only pays 6 of them. There can be many reasons this may happen, and in nearly every case we are taking action to get these claims paid.
While other therapy clinics and physician offices typically bill you the full amount for unpaid claims, forcing you to call your insurance company to resolve the situation, we attempt to resolve these “behind the scenes” without your involvement. In most cases, our efforts are successful, although full payment might not be received for some time. When we finally receive payment, you are then billed for coinsurance and deductibles. Check the EOB issued by your insurance company for details.
Category #3 – Payment Amount Confusion
Why does my statement show that I made 5 payments of $20, but I actually paid $30 and $70?
When payments are applied on our system, it has to match a charge to a payment. Therefore, if you owed $10 per visit (for copayment or coinsurance) 10 visits, then each payment will be broken down and a piece applied against each visit balance. Check the date of the applied amount to verify.
Category #4 – Conflicting Insurance Plans
Why am I getting a bill? I thought CHP paid for my child’s therapy? What do I do now?
Please remember that the Children’s Health Insurance Program (CHP) is intended for children without insurance coverage. If your child had insurance coverage available (usually through a divorced parent without primary custody) and you did not provide us with that insurance information, then you are now getting a statement because your CHP insurer contacted us and either forced us to refund the payments we received for services (a recoupment of funds) or denied payment for therapy because your child had another insurance available to pay for that therapy.
If you haven’t already, provide us with the alternate insurance coverage immediately. We can still attempt to file with that insurance plan, however, insurers have timely filing limits we have to observe. If our claim reaches the insurer too late for payment as a result of your negligence in providing us full coverage information, you will be liable for that bill, and may contact us any time to establish a payment plan.
Why am I getting a bill? I thought Medicare paid for my therapy? I have another HMO card too.
If you have a Medicare Advantage Plan, then you must provide that coverage information rather than your Medicare information. Claims submitted to Medicare will be denied if you have a Medicare Advantage Plan that replaces your normal Part B outpatient coverage.
Please note that you must provide this coverage information as soon as possible to avoid denial due to late submission. With most Medicare Replacement HMO plans, there are pre-authorization requirements. If your plan required re-authorization for therapy and we did not obtain it (because you did not provide the correct insurance coverage information) then the insurer may choose not to authorize therapy retroactively, and you will be responsible for the amount due. Please contact us to discuss your options as soon as possible.
Why am I getting a bill? I thought Medicare paid for my therapy? I have a nurse coming to my house too.
If you are currently receiving any home health services (to include a nurse) covered by Medicare, then your home health agency has certified that you are not well enough to attend an outpatient clinic for therapy. They have also agreed to submit all requests for therapy to Medicare, and Medicare has agreed to pay them for any therapy that you require.
The catch is that Medicare needs your home health agency to submit requests for therapy in advance or at the start of your home care. If you have attended therapy in our clinic and were under the care of a home health agency, you can ask the home health agency to pay for the therapy that we provided. Please contact them, give them our contact information, and we may be able to work out an agreement. Understand that they are under no legal obligation to pay us, however.
These are most, but not all, of the common questions we encounter. Check back for more as we compile them over time.