Q. What are my financial responsibilities as a patient?

A. As a patient, it is in your best interest to know and understand your insurance plan benefits and your responsibility for any deductibles, co-insurance, or co-payment amounts prior to any visit. Not all services are covered in all insurance contracts. If your insurance plan does not cover a service or procedure, you may be liable for full payment of the bill.

To find out what your insurance plan covers and what your financial obligation may be, call the Customer Service or Member Services Department of your insurance company (the phone numbers are on your insurance card). Your employer’s human resources department may also be a source of information and assistance.
Make sure that your insurance company lists both your physician and hospital as a participating provider. It is possible that only the physician or only the hospital participates with your insurance plan. Benefit and coverage rules and policies differ among insurers and even between different plans of the same insurer. If you go to an out-of-network provider, you may have a greater financial responsibility for services provided at a hospital that is not under contract with your health care plan.

Your insurance company can assist you in finding an in-network provider to limit the amount of money you will have to pay for care. Contact your plan’s Customer Service department for further assistance.

Q. I was a patient at the Hospital. Why have I been sent two bills? What is included on each bill?

A. During the course of your visit to the hospital you may receive a variety of inpatient or outpatient services and treatment. You may receive two bills for each of these services or encounters. These are not duplicate bills.

One bill will be for services provided by the hospital, the other for services provided by the physician(s) involved with your care. These may include physician fees not only from your primary physician, but also from consulting physicians, anesthesiologists, radiologists, pathologists, and others who performed services for you. The hospital bill will include charges for the hospital room, nursing care, meals, supplies, medications, and other miscellaneous items. The hospital bill also will include technical charges for X-rays and lab tests while the Physicians Group bill may include physician fees for interpreting those same tests.

For outpatient care, the hospital bill will include physician fees associated with diagnostic testing and most outpatient procedures.

Q. What if my insurance plan requires a referral and/or a prior authorization?

A. If your insurance company requires a referral and/or prior authorization, contact your primary care physician prior to seeing a specialist.

If your insurance company requires a referral and/or prior authorization and you do not have one, you may not be seen for your scheduled appointment, or you will be responsible for full payment of your bill at the time of service. If your specialist requires more visits than your insurer approves or if the referral has expired, you must contact your primary care physician for another referral and/or prior authorization.

Q. What should I do if my insurance changes?

A. You are responsible to notify us of your insurance and changes to your coverage. Please have your current insurance card with you at all times, as well as a photo ID such as a driver’s license, military ID or government issued ID.Please have your current insurance card with you at all times, as well as a photo ID such as a driver’s license, military ID or government issued ID.

Q. Why are you asking for my deductible, co-insurance or co-payment at the time of my visit?

A. We ask that payments be made when you are at the physicians office so you won’t be bothered with an invoice sent to your home after your visit. It also helps us reduce our costs and saves you the trouble of mailing a payment back to our office.

Whether you have insurance coverage or not, you as the patient are ultimately responsible to make sure your bill is paid. If you receive a statement showing that your insurance company has not paid, it may be helpful for you to contact your insurance company to ask why payment has not been made.

 (All correspondence with our office should include the patient's name, date of birth, and account number, )

© 2012 Dr.Stanford Internal Medicine   •   29798 Haun Road, Suite 308   •   Sun City, CA 92586      Phone  951.301.7611   •   Fax  951.301.7616