We feel your pain. Medical billing is complicated for us to.
At Altitude Family & Internal Medicine, we understand how complicated and confusing medical billing process and the statements you receive may seem. This section will hopefully help you have a better understanding of the medical billing process, and answer common questions that you might have.
The U.S. Department of Health and Human Services (HHS) through the Centers for Medicare and Medicaid Services (CMS) in association with the American Medical Association (AMA) establish and publish coding regulations used by Medicare and private insurance carriers to process medical claims. Altitude Family & Internal Medicine follows these published guidelines when it submits claims, and this may affect your bill.
Yes. We are happy to bill your insurance company for the services you receive as a courtesy to you. As a courtesy, we will file all claims for our service with your primary insurance company. If you have secondary insurance, we will automatically file a claim with them as well. Once we know your insurance has paid in full on their portion of the bill, the remaining balance of the bill will become the patient’s responsibility and accordingly an invoice will be sent.
Alternatively, you may pay your balance in full and then submit the claim to your insurance company for reimbursement.
Services billed on your behalf are provided to you on credit, with no guarantee your insurance will cover any or all services provided. Please be advised that the ultimate financial responsibility for services provided does not belong to your insurance company, but to the person receiving the services or their guardian.
Your medical insurance policy is a contract between you and the insurance carrier. Altitude Family & Internal Medicine is not a party to that contract. Your coverage, the requirements for pre-authorization, pre-certification, specialist counseltation, deductibles, co-payments and co-insurance are all defined in your policy. You are responsible for reading, understanding, and following the procedures outlined in your policy handbook. We will be happy to assist you when and where we can with specific questions and concerns.
Your employer, insurance agent, or the federal government determines the range of benefits eligible to you.
Our policy regarding the collection of copays is based on federal regulations established by the U.S. Department of Health and Human Services, as follows…
“It is unlawful to routinely avoid paying your copay, deductible or coinsurance payments… even if your doctor allows it.” Unless you complete a “Financial Hardship” form and qualify for financial assistance under Federal Standards, you may NOT routinely evade paying your responsibility portions for medical care as outlined in your insurance plan even if your doctor allows it. You both may be charged for breaking the law. This includes services deemed as “professional courtesy” and “Take what insurance pays.” Failure to comply places you in violation of the following laws:
Federal False Claims Act
Federal Anti-Kickback Statute
Federal Insurance Fraud Laws
State Insurance Fraud Laws.
Failure to comply may result in civil money penalties (CMP) in accordance with the new provision section 1128 A(a)(5) of the Health Insurance Portability and Accountability Act of 1996 [section 231(h) of HIPAA]. Exceptional cases may apply.
Thanks for asking, and as a matter of fact we are.
- We maintain compliance with the latest, most stringent medical billing guidelines
- We use a nationally recognized third party billing service with certified billers and coders
- We file all claims electronically using trusted and proven billing technology
- We have initiated a more effective, color-coded patient statement designed to minimize confusion
- We have made your account information available to you 24/7/365 via our secure web portal
- We have created an online payment option via our secure web portal
Altitude Family & Internal Medicine accepts cash, major credit cards, and debit cards.
We can also keep your credit card on file in our secure system.
Additionally, you may pay your balance at any time online.
This is an area where unfortunately we are both victims of the healthcare system. Typically your claim will be sent from our office within one week of your appointment, and if everything goes smoothly we expect to receive a reply from your insurance company within 60 days. Given the current complexity of the billing process, however, the claim submission process can take up to 90 days, and the insurance response process may take up to an additional 90 days. When there are unexpected problems with the claim, this time can double. This process will also take longer in cases where there is a secondary insurance to bill. Be assured that we will do everything in our power to expedite this complicated and sometimes time consuming process.
By law, medical providers must accurately specify the type of treatment they provide to a patient, whether preventative, problem-related, or procedural in nature. Health insurers base their coverage determinations from the procedure and associated diagnosis code(s) submitted for claims processing.
Federal guidelines specify that a provider must code and charge for preventative care, such as an annual physical exam, separately from problem-related care (i.e., sprained ankle, cough, or high blood pressure), or from procedural care when the services are performed at the same visit. For example, if you receive treatment for a specific health problem during your physical exam, your physician is bound by established coding regulations to submit a separate code and charge for this service. Please be assured that in these circumstances the quality of care you receive will not be affected.
Most insurance contracts require us to submit a charge to them that is near the national average for similar practices. We typically use an amount near the 50th percentile based on data obtained from the American Medical Association.
The charge that we submit is largely irrelevant, as the actual payment is based exclusively on a discounted rate that has been negotiated for you by your insurance company.
The difference between the contracted rate and submitted charge is noted on your EOB or bill as an “adjustment.”
For an example of a discounted fee schedule, feel free to take a peek at our discounted fee schedule for self inured patients.
You are probably looking at code 99211, which many of the insurance companies inappropriately label as a “nurse visit.” In reality, there is no such thing as a ‘nurse visit.’ Code 99211 represents an “office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician” as defined by CMS and the AMA. This is the appropriate code for us to use when you are seen in the office for a minor issue that does not require direct contact by a medical provider.
This is another case of mistaken identity. Often the insurance companies will label any procedural code as ‘surgery.’ In reality, the service performed may have been something to the contrary such as splinting of a sprained ankle, freezing of warts, or even a hearing test. We have no control over how the insurance company chooses to label things, but be assured that we are using the appropriate codes and following the established coding guidelines.
Certain physicians help with your medical care even though you may not meet them. Commonly, these are the doctors who read your lab results, X-rays and EKGs, or doctors who supervise other providers, among others.
We certainly apologize for any errors that may have occurred on our end. We employ multiple levels of error checking to prevent errors in medical billing, including training our providers to expertly code, using electronic medical records, employing certified professional coders to manually review claims, using the latest claims auditing software, and submitting claims electronically. Medical billing has become so complex that even with all these systems in place, periodically there will be an unintentional error. Please use the contact information below to notify us if you think there is an error on your account.
Billing questions and concerns should be addressed with our patient financial services department, who may be reached toll free at (855) 689-8166. If you have additional questions, your medical provider will do their best to answer any questions about the services you are receiving.