Billing QA

Billing

Most of our billing is done based on the time spent. We spend time in multiples of 20 minutes (CPT 99213) or 30 minutes (CPT 99214) as the need be. 

The time spent involves not just your time of interaction with your provider but also coordination, consults with other providers, clinical reconciliation, prescription reconciliation, communication with other facilities likes labs, imaging, home health care and so on. 

Prevailing Rates

The shown below is  a screen grab from Fair Health Consumer. These rates are published to keep patients from getting over charged. As you can see fair price for 30 minute visit a doctor in our neighborhood is $158.  In addition there is $179 facility fee added when you see a hospital owned practice (University of Colorado, Health One and Centura Health own many primary care practices in Denver Metro Area and they charge additional fee because they can charge)

So a primary care practice in our zip code has a fair price of $300 for half an hour consult.

Our Rates

Our rates are extremely affordable compared to above fair prices. We charge $129 for half an hour visit.  This is below that of the lowest cost provided at https://fairhealthconsumer.org. To receive these rates you must be a self pay patient and must not use private insurance. If you use private insurance, we go by contracted rates as agreed by the insurance. 

Your bill

Your bill always is generated after multiple rounds of negotiation with your insurance. Some of these insurances have timely filing requirements and process claim with 90 days. Some take up to an year. So your bills may be delayed till your insurance has processed the claim. But once the insurance has processed the claim, they send you an Explanation of Benefit (EOB) and send us a claim response which shows patient responsibility. We generate an invoice as soon as we receive claim response and send you your invoice electronically through email or text notification. The bill is immediately due and charged to a card on file.

Why Card on File?

This is no different from your other utility bills. Your utility collects the charges from your card before providing service (phone companies charge you for the month ahead) . We charge you for the amount owed.  Insurance companies insist that patient must pay patient responsibilities at the time of service yet do not provide estimation of patient responsibilities. So we keep the card on file and charge as soon as insurance company has adjudicated your claim.

Why do you charge card on file as soon as insurance adjudicates?

As you can see, we have already waited up to an year, (in some cases) after delivering the service. Since patient is responsible for these payments at the time of service these were already due. However we give a grace period of five days so that you can also pay using other means. At the end of five days the card on file is charged.

What if card on file is declined?

Our affordable rates are because of automation in the billing. If a card is declined and if a bill is unpaid we manually bill you after adding a processing fee of $25 for the declined check/card and manually process your new payment;  

Why did I receive a large bill this month, when I did not use you this month?

As already explained, the visit fee for a visit is around $129. If you have received a large bill, it is from your previous visits because older bills get consolidated. 

Why my insurance did not pay?

We can not answer that question. We try our best to get reasons for denial and work the denials and appeal them as much as we can. Only when everything fails we send you a bill. 

You said you accepted my insurance, but why are you billing me now?

When we say we accept your insurance, it means we submit claims on behalf of you to your insurance. It does not mean that your insurance accepts your claim.  Unfortunately we too get hurt when insurances do not pay. 

How do I avoid paying large bills?

Our system identifies high deductible plans and tries to collect $100 at the time of service. This is in line with Insurance contract that we must collect deductibles at the time of service. If you pay $100 your responsibility later will be reduced by $100 and your final bill will be smaller. 

I have a billing issue, whom should I contact?

If your issue is related to the  insurance not paying, then call the insurance. If your issue is because your previous payment has not been applied to your bill, then please creating a ticket using https://carrie.nhpc.us/open-a-ticket

What happens to unpaid bills?

 We work hard to get a resolution. If you have trouble paying please contact us and request for once a lifetime discount of 50 percent discount if you are able to pay it promptly. This prompt pay discount is provided only if the payment is paid in full and in extreme hardships.  If  an unpaid bill remains open for more than 30 days, it is sent to collection. Collection agencies add their own collection charges and also report the debts. Once you are in collection you stop being our patient unless the amount is paid in full.

Waive off my bill else I will write a fake review on Internet that I received a large bill which was incorrect!

We expect the review to be factual. We generally do not respond to reviews. However we have a reputation to protect and respond with a link to this Q&A so that everyone knows how to avoid billing issues. We request you to be nice to the provider who took care even when the bills were not paid. Please read this Q&A again to understand how the billing issues can be avoided.