Helpful billing terms:
Explanation of Benefits (EOB): A statement an insured member receives from an insurance company that lists the services provided at PhysicianOne Urgent Care, the amount billed, any insurance payments, and patient responsibility.
Co-pay: A specified dollar amount that is determined by a patient's insurance company, and paid out-of-pocket toward a specified service at the time of service.
Deductible: A specified financial amount agreed upon by the insured member and the insurance company that an insured member must pay toward medical services before the insurance company will make any payments. Common deductibles can range anywhere from $2,500.00 to $5,000.00 per individual and can be as much as double for a family.
Guarantor: Someone, who may or may not be the patient, who either accepts or is legally responsible for the payment of bills for medical services. The guarantor is often a parent or guardian of a minor child.
Patient Responsibility / Financial Responsibility: The amount of a medical bill that a patient is required to pay.
Insured Member / Subscriber / Beneficiary: Someone who has medical coverage through a health insurance company.
In-Network: When a doctor, hospital, or other healthcare provider participates in an insurance plan's network, the provider agrees to accept your insurance payment for covered services as payment in full (minus your deductibles, co-pays, and co-insurance amounts).
PhysicanOne Urgent Care participates with many plans.
Contact your insurer for specifics about your plan.
Out-of-Network: When a doctor, hospital, or other healthcare provider is not part of an insurance plan's network, it is considered a Non-Participating or Out-of-Network Provider. If a patient receives medical services from an Out-of-Network Provider, the patient may be responsible for higher costs or the payment in full (for all services rendered).
Statement Balance: The amount that a doctor, hospital, or other healthcare provider charges a patient after the patient's insurance company, or Medicare has paid its approved amount.
Co-insurance: The portion of the balance for covered medical expenses that an insured member must pay after payment of the deductible. Examples are 10%, 20% co-insurance. The co-insurance is often collected at the time of service.
Pre-authorization: The process of obtaining permission to perform a service from the insurance carrier before the service is performed. Pre-authorizations are often needed for CT scans and MRIs in the Urgent Care setting.
Always contact your insurance carrier with specific questions regarding your plan and coverage.
