Billing Frequently Asked Questions
How do I contact someone in billing?
Our billing department does not take direct phone calls. If there is a need to speak directly, we can call you. We are also available to discuss issues on a conference call with you and your insurance company. The best way to contact us is via email: firstname.lastname@example.org. Once you send this email it is expected you will receive a response within 3 business days. Please do not contact your doctor with billing questions or issues.
How is payment to the doctor determined?
If the doctor is in network with your insurance company there is a contract between the doctor and the insurance company that determines payment for each service. The doctor is eligible to only receive the contracted amount for a particular service. The amount for which you are responsible depends on your insurance plan. We encourage all our patients familiarize themselves with their insurance plan, and to be aware of what services are covered and not covered. Any amount that is not covered by our contract with your insurance company is your responsibility
I would like to know how much is being charged and what my responsibility be for each service provided. How can I find this information?
This issue is a huge challenge in healthcare. We do our best to be transparent about pricing. We are always happy to tell you gross pricing up front. However, this price never reflects the amount that will be reimbursed by your insurance company or how much your obligation will be. The insurance companies hold this information closely and do not tell us ahead of time how much your obligation will be for a given service. To make it more complicated, these rates are constantly changing and are dependent on an individual’s insurance plan and not necessarily the particular payer (i.e. the insurance company). Your doctor does not know this information ahead of time. Our front desks staff and our billing staff all have access to the gross prices. But as above, no one knows for sure what your obligation will be once the bill is sent in. We are always happy to help with questions.
I saw Dr. X but the billing was done under Dr. Y. How is that possible?
We are a rapidly growing medical practice. It can take 6-9 months (or longer) for a new doctor to become fully credentialed with the insurance companies. During this time, we utilize “billing supervisors”. These are physicians in our practice who are already credentialed with your insurance plan. This practice is accepted by the insurance companies as an interim measure to ensure patients receive care.
MLM / my doctor are in network. Why am I receiving a bill from you?
The only time MLM generates a bill for a patient is when the patient’s insurance company tells us that the patient has incurred a cost beyond what the insurance company will pay. This information comes in a document from the insurance company called an explanation of benefits (EOB). The only bill you will receive from MLM is for the amount stated in the EOB. This is your contractual obligation and under NYS Law cannot cannot be negotiated or reduced except in special legal circumstances such as bankruptcy.
My credit card was charged without notification. How can you do this?
Our practice policy is that all patients keep a credit card on file. This is designed to cover no-show fees, co-pays, deductibles, non-covered services and any other items outlined in your EOB. This works the same way as leaving your credit card at a hotel upon check-in for “incidentals”. All patients sign an agreement allowing us to use the credit card on file for this purpose. This agreement is signed at check-in at the beginning of every visit.
The receptionist told me I do not or would not owe any money so how can I now owe?
We do our best to educate our office managers and front desk staff on all aspects of our practice, but it is impossible for them to handle all situations. We generally expect that all questions regarding billing and payment are directed to our billing team. Unfortunately, even if our front desk staff or office managers have advised you incorrectly that does not relieve your payment obligation for services.
Why is the doctor’s fee higher than what the insurance company will pay?
Our fees are determined by a percentage of what is known as usual and customary rates (UCR). These rates are generally accepted across the industry for a given geographic area. As you might understand, in NYC these rates are higher than in other parts of the country. These rates are always higher than our contracted rate with the insurance company. The reason for this is that we have many different contracts with insurance companies and they all come in at different rates. The difference between our rate and the contracted rate is not your obligation. We write this amount off as a contractual obligation.
Why am I paying a co-pay for an annual exam?
Under the Affordable Care Act there are no co-pays for annual exams. However, it is extremely common to receive services at the time of your annual exam that are not included in an annual exam (which is a well-person visit designed to address preventive health issues only). When such services are rendered your insurance company considers this an extra visit. We do as well. This is an additional service provided above and beyond what is included in a normal brief annual exam. Even if it is 5 minutes of counseling it is still an extra service. This is consistent with all federal correct coding guidelines. When you receive a fee for this it is not a co-pay for your annual exam but rather a copay or deductible for the extra service. Examples of these extra services include but are certainly not limited to any of the following:
- Chest pain
- Vaginal symptoms
- Painful intercourse
- Birth control counseling
- Fertility counseling
- Abnormal bleeding
Why am I receiving a bill from the laboratory (MLM, Sunrise or Quest)?
Many insurance plans require you pay a portion of the laboratory fee. We have no control over this fee or your obligation to pay this fee. Any questions about such bills should be directed to the laboratory company and your insurance company. Sometimes, we can help with the bill by offering the laboratory company additional diagnosis information.
In the past I didn’t have to pay a deductible or copay for a particular service – why now?
While billing errors can occur the most likely reason for having to pay for something that you did not have to pay for in the past is simply that the landscape of medical reimbursement is changing. In the past, employers and government entities paid for over 90% of expenses. This is no longer the case. Through various mechanisms, including your policy agreement with your insurance company, costs are increasingly being shifted to the patient (consumer) directly. It is important for you to know all the expenses, covered or not covered, with your insurance policy.
I am not getting all the answers I need from the billing department. Who can I speak to?
Our whole organization including our managing partner, Dr. Kenneth Levey Maiden Lane Medical take great pride in providing you with outstanding care as well as always striving for 100% satisfaction with every visit to us. If you have any issues or questions not addressed by our team in any aspect of your care, please email him directly at email@example.com.