It is our goal to make sure all patients understand how they will be billed before they receive their first statement. We understand that it can be quite confusing and we will work to help you understand all elements of the billing process.
If you are having a procedure done in one of our affiliated hospitals or surgery centers, there are many people and facilities involved in the success of your procedure and you will be billed for all the elements of the procedure.You may receive up to five separate fees for different services. Below is a list of the potential groups or doctors that may bill you.
All bills will be sent to your insurance carrier first. Any balances that the insurance does not pay will be your responsibility. If you are not sure what your insurance will cover please contact your insurance carrier for more information on your covered benefits.
Hospital or Surgery Center – This includes the facility fee that the hospital or surgery center charges. This covers the cost for the staff, equipment, and supplies that are used during your procedure.
Physician Services – This is the bill for the physician’s time to conduct the procedure and it is billed from the Physician’s office.
Radiology Services – These fees will be charged for imaging such as X-ray, MRI, or CT scan. This fee may include two parts: the handling of the sample and the reading by a radiologist.
Pathology or Laboratory – These fees will be billed for anything that is sent to a laboratory for testing. This may include tissue samples, blood tests, or cultures. This fee includes two parts the handling of the sample and the reading by a pathologist.
Anesthesia Services – The services of anesthesiologist are generally required for surgery. You will be told if anesthesia is to be used ahead of time. The anesthesiologist will bill you for the medications administered and the physician’s time.
How to Read Your Explanation of Benefits (EOB)
Total Charges – This is the total amount each provider has billed to your insurance provider
Allowed Amount – This is the total amount expected to be paid by the insurance and or the patient combined (also called the Negotiated Amount or Contracted Amount)
Payable Amount – This is the amount that the primary insurance will pay.
Patient Responsibility – This is the difference between the payable amount and the allowed amount. This represents any deductibles, co-payments, or co-insurance that you may be responsible for. If you have a secondary insurance they may pay for all or part of the patient responsibility depending on your benefits.
If there is an error or question on your account, please contact the friendly people in our billing department at (949) 791-6767. Many times a phone call can help clear up any misunderstanding about your charges.