Have questions about insurance and billing? We have answers. Payment for healthcare can seem complicated and confusing, but we broke down all of the jargon for you. Take a look at some of the most frequent questions we get asked and the steps involved in the billing process.

Frequently Asked Questions Regarding Insurance

What are managed care plans?

Managed care plans are a type of health insurance that has contracts with health care providers and medical facilities to provide care for members. The health care providers and hospitals enter into a contracted agreement to provide care for the plan’s insured members at reduced costs (contracted fee schedules).

What is the difference between a deductible, a copayment and co-insurance?

All three are financial obligations the insured must pay out of their own pocket. The deductible is the initial amount the insured must pay each year for covered health services before the insurer will start making payments. A copayment is a fixed amount that the member pays toward each medical service, such as an office visit. Co-insurance is a fixed percentage the insured must pay once the deductible responsibility has been met.

What is a pre-authorization?

It is a requirement by your insurance company that certain health care services, treatment plan, prescription drug, or durable medical equipment be reviewed by them to determine if they are medically necessary. Even though the preauthorization renders the services, treatment plan, prescription drug or durable medical equipment medically necessary, it is not a guarantee that insurance will cover the cost.

How do I know if the provider of services is in my network?

The best way to find out is to contact your insurance company and ask if the provider you are seeking care from is in your network. You can also contact our Billing Office at 513-229-3903 for assistance.  

Do I need to bring my insurance card to every visit?

All patients are required to present their current insurance card at time of service even if you have provided the information over the phone when scheduling your appointment. The insurance card has very important information that we need in order to file a claim correctly and maximize your benefits. It is also important to have your insurance card on file if you are expecting, require surgery or other testing. It allows us to pre-authorize any required procedures with your insurance company to avoid your claim from being rejected.

Do you accept credit cards?

We accept every major credit card, personal checks, and cash. If you like, credit cards can be kept on file to be used for future balances. Co-payments are due at the time of service.

How Our Billing Process Works

  1. Patient schedules appointment via phone or online appointment request form.
  2. Patient receives a confirmation of the appointment via text/email.
  3. A few days before the scheduled appointment an eligibility and insurance check is done electronically through Phreesia to determine if insurance information on record is still active and if a copay is due at the time of service.
  4. Patient is contacted if new insurance information is needed to make sure we are in the network.
  5. An invitation to “pre-register” through Phreesia is sent via text/email 3 days prior to the scheduled appointment.
  6. Patient receives an appointment reminder via text/email/phone 2 days prior to scheduled appointment.
  7. Patient checks in at the front desk via a tablet unless they have already pre-registered. Co-pays and past due balances are collected.
  8. Patient meets with the physician, charts in the patient’s electronic health record and marks the electronic encounter form for services rendered.
  9. A request is sent to the surgery scheduler for patients who need surgery or outpatient testing.
  10. Patients are checked out and follow-up appointments scheduled per the doctor’s request.

Still have questions? We are still here to help! Feel free to contact us if you have any further questions.