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Patient Guide

Patient Guide

Frequently Asked Questions

We know that healthcare bills can be confusing. We have compiled some of the questions most often asked by our customers and hope the answers will help you better understand healthcare billing.


GENERAL FAQs

1. I have questions about my bill. Who can I contact?

Our customer service representatives are available to help you with any questions or concerns you may have about your bill. For your convenience, we have posted answers to some of the most frequently asked questions on this website. If you cannot find the answer to your question here, please call our representatives at (717) 851-6816 or (800) 839-1404 between the hours of 8 a.m. and 4:30 p.m., Monday through Friday.

2. I called Physician Billing Service once before, but my issue remains.

In some cases, changes to a patient's account might take some time to resolve. Should you see that a requested change did not take place, please call us. Make sure you obtain the name of the representative who assists you every time you telephone us at (717) 851-6816 or (800) 839-1404, so we can track our service.

3. It has been months since I saw my physician and I am only now receiving a bill.

Some insurance plans take up to 90 days or longer to pay a claim. If we participate with your insurance, during this time we do not send out information to our patients regarding their billing activity, as we have found this action often confuses our patients. Upon receipt of payment from your insurance carrier, you will receive a bill from Physician Billing Service for any remaining balance, which includes details of your insurance payment activity and other useful information.

4. When do I become responsible for paying my bill?

You are legally responsible for your bill at the time you receive services from the provider. We require all patient balances be paid immediately after you are notified.

5. How do I request another copy of my bill?

Call Physician Billing Service at (717) 851-6816 or (800) 839-1404.

6. May I email you my concerns?

Yes. Click here to e-mail Customer Service.

7. What if I recieve more than one bill?

You may receive more than one bill for the same visit. These bills are for services provided by physicians, anesthesiologists, radiologists or other healthcare professions. If you have questions about a specific bill, please call the phone number listed on that bill.

8. What is the standard billing process?

If you have provided your insurance information, we will file your claims with your carrier. If we do not have a contract with your insurance, you will be required to pay for office services in full at the time of service. As a courtesy, we will then submit your claim to your insurance for reimbursement to you. If you provide us information on a secondary carrier upon receipt of payment from your first carrier, we will bill them as well.

You should receive an explanation of benefits (EOB) from your insurance company explaining what they paid. We find that insurance companies usually mail the explanation of benefits to you one or two weeks prior to sending us the check, therefore the payment may not appear on your next bill. We will send you a timely bill to keep you informed of your account status. If payment is not received in a timely fashion from your insurance carrier, we will request your assistance in contacting your insurance carrier for payment.

9. What if I find an error on my bill?

Please call our customer service department at (717) 851-6816 or (800) 839-1404, and speak with one of our customer service representatives.

10. When will I receive a bill?

If you verified your insurance information when you registered and we participate with your insurance, you will not receive a bill until:

  • Your insurance company denies your claim;
  • Your insurance company pays the claim, leaving a coinsurance, deductible or non-covered services;
  • Your insurance company hasn't responded to the claim.

If we do not participate with your insurance you are responsible for making payment at the time of service.

11. How can I check on the status on my account?

If it has been at least 45 days since the date of service, contact your insurance carrier for the status on the claim. If, after speaking with your insurance carrier, you still have questions regarding the claim, contact Physician Billing Service at (717) 851-6816 or (800) 839-1404, and a customer service representative will assist you.

12. Who is the "guarantor"?

The guarantor is the person legally responsible for all charges incurred by the patient. If the patient is over the age of 18, then they are listed as their own guarantor. Exceptions would include:

    • Full-time high school/college students covered under their parents' insurance. If parents are divorced or separated, the custodial parent is the guarantor. If the custody is equally shared, the parent who has the insurance coverage on the patient is the guarantor.

    • If a patient is mentally or physically challenged, and resides with a parent, the parent is the guarantor. If the patient lives in a group home, the patient is his/her own guarantor.
       

If the patient is under the age of 18, the guarantor is determined as follows:

    • If both parents are married to each other and live at the same residence, the primary policyholder is listed as the guarantor. If there is no insurance coverage, the father would be the guarantor.

    • If parents are divorced or separated, the custodial parent is the guarantor. If custody is equally shared, the parent who has the insurance coverage on the child, is the guarantor.

If the following applies to emancipated minors, then the patient/minor is their own guarantor:

    • An individual who fathered a child.
    • An individual who mother (gave birth) to a child.
    • An individual who has a court ordered document indicating that the patient/minor is emancipated.

13. Why must I register more than once at WellSpan?

Although we are the same company, our registration systems currently do not share a common database of patient information. At this time each WellSpan entity has a unique record for patients who are seen at that facility.

14. Why didn't my insurance pay my whole bill?

Once your insurance carrier pays their portion of the bill, they will send you an explanation of benefits (EOB) to show how the claim was paid. You can compare your EOB to the bill sent by Physician Billing Service. How the carrier paid the claim is based on their contract with us and their contract with you. If you feel the insurance company should have paid a higher amount, please contact them directly for resolution.

15. Will all of my insurance(s) be billed?

Yes. The billing of insurance is a courtesy to you. Your insurance policy is a contract between you and your insurance company. Communication with your insurance company is your responsibility.

16. I received a letter from my insurance company asking me about a visit to my doctor. It is asking me whether my visit was related to an accident. I have not been involved in an accident, what should I do?

Medical treatment related to an accident is often covered by auto or workman's compensation insurance. Your health insurance plan simply needs to know if your medical expenses should be billed to another insurance company. Please answer the questions appropriately, and mail the questionnaire back to your insurance company. If you do not respond, your claim will be denied and you may be responsible for payment.

17. What is this "HIPAA" I keep hearing about?

For further information about the Health Insurance Portability and Accountability Act (HIPAA), please click here for more information.

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 PAYMENT FAQs

1. Can I pay with a credit card?

Yes. For your convenience we accept Visa, MasterCard, and Discover.

2. How do I make a payment?

Please pay the balance due by detaching the bottom portion of your bill and include your check, money order, or credit card information (include the credit card expiration date) in the envelope provided. Or, you can pay your bill online. We are also happy to assist you with your credit card payment over the telephone. If you have further questions or would like to speak with a customer service representative, please call our Customer Service Department at (717) 851-6816 or (800) 839-1404, Monday through Friday, 8:00am to 4:30pm. Please have your account number available.

3. Can I write one check to cover all the bills?

You may write one check to cover all bills only if the address listed on the bottom portion of your bill is the same on each of your bills. The bottom portion of your bill is the portion that you return with your check.

4. Which bill can I pay online?

You can pay any WellSpan Medical Group bill online, as well as a bill from WellSpan York Hospital.There are two options for online payment.

  1. Pay It Now allows you to make and online payment for a bill you have already received.
  2. You can also "Enroll" to receive a notification of your bill via e-mail. A link will be included which will allow you to view your bill online and make a payment.

To proceed to the online bill paying system, click here.

5. What if I can't pay my bill? Can I pay in installments?

In some circumstances a budget plan may be established, within specific budget guidelines.  If you cannot make payments, a Healthy York Network Financial (Hardship) Application can be mailed to you upon request.

The budget will be set up for the amount of your account when the budget is established. Any new charges are not included in the budget and if you need to have them included, you must call our Customer Service Department to re-establish a new budget arrangement. Budgets are established per patient not per family. Please call our Customer Service Department to arrange this agreement. Bills are mailed monthly.

6. Do I have a co-payment or deductible?

Most insurance companies have co-pays or deductibles. It is the policy of WellSpan Health to collect these co-pays or deductibles at the time these services are provided. If the patient is having an elective service or a service that is NOT covered by his/her insurance company, appropriate payment will also be requested at time of service and additional forms may need to be signed.

NOTE: If you are unable to make payment at time of service, WellSpan Health offers several payment options to assist you at time of service, and we also accept all major credit cards.

7. When do I pay my co-payment or deductibles?

Co-payments are due at the time of service. If you are unsure of your co-pay responsibility, please contact your insurance policy. Knowing your insurance policy is vital to receiving the maximum possible benefits.

8. Do I have to pay my co-payment at the time of service?

Yes, you are expected to pay your co-payment after services are provided.

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INSURANCE FAQs

1. According to my EOB, I'm only liable for a certain amount of money and the balance is written off, as my physician is a participating provider.

If there is a discrepancy between what was paid by your insurance and what we are billing, please contact our Customer Service Department at (717) 851-6816 or (800) 839-1404 with your information. We will be happy to review your information with your insurance carrier to ensure the correct adjustment was made.

2. What part of the balance am I responsible for when my insurance doesn't cover services?

If there is a balance that was not covered or paid by your insurance, or co-insurance, then you are responsible for the balance due as soon as you receive a bill.

3. My insurance information is incorrect on my bill.

We apologize for this error. Please have your insurance card available and contact us during our normal business hours 8:00am to 4:30pm, Monday through Friday, at (717) 851-6816 or (800) 839-1404. We will make the necessary changes to your account and re-bill the correct insurance plan.

4. Why do I have to pay when I have insurance?

Most insurance carriers expect you to pay a deductible and/or co-payment. You may also be required to pay any non-covered charges as deemed necessary by your insurance carrier. Your insurance benefit representative for your employer can explain your benefits to you. If we do not have a contract with your insurance, it is WellSpan's policy to collect payment in full at the time of service. As a courtesy we will then submit your claim to your insurance to assist you with reimbursement.

5. How do I know if my insurance company will cover my visit/services?

Coverage varies with each insurance company. We encourage you to check with your insurance company or your employer about this. Generally, our providers do not know whether a particular service will be covered. Medically necessary and appropriate services may not always be covered by your insurance contract. Please refer to your insurance member handbook or call your insurance company with questions.

6. Will you bill my insurance company for me?

Yes, as a courtesy we will bill your insurance company. However, WellSpan asks that you participate in helping us to obtain necessary authorizations, insurance card copies, referrals, and other critical documentation in order to smoothly expedite your care and reimbursement for services rendered.

7. How will I know if my insurance company has paid my bill?

If there is a balance due from you after the insurance company has paid its portion, we will send you a bill. This bill indicates the amount that has been paid and any balance you are required to pay. This is your bill. You are required to pay this bill in full or will need to contact our office.

8. How do I follow-up with my insurance company?

Before you call, have available your insurance card, date of service, facility name, original billed amount, patient name and claim number if applicable. Obtain satisfactory status of account. If paid, ask when and to whom. Note this information and with whom you spoke at the insurance company. If the bill has not been paid, find out when the anticipated payment date is and ask if they need anything from you. If the bill is not paid in the stated timeframe, follow-up with the insurance company again and, if necessary, request to speak to a supervisor.

9. What do I do if I disagree with how much my insurance has paid?

If you disagree with the insurance company's payment amount, contact the insurance company and ask them to review how the claim was processed. If the insurance company finds that an error was made, note the information and with whom you talked at the insurance company. Request an anticipated payment date and ask if they need anything from you. If the insurance company feels the bill was paid correctly and you still disagree, find out from the insurance company what you need to do to file an "appeal" with them. Filing an appeal will not guarantee that the insurance company will pay more on your bill, but the claim will be reviewed for reconsideration.

10. Who do I contact to update and/or re-bill my insurance?

You will need to call Physician Billing Service at (717) 851-6816 or (800) 839-1404. If possible have your insurance card available when you call.

11. What should I do if my insurance denies my claim?

If you feel the claim has been denied in error, contact your insurance carrier for a detailed explanation on the claim. Physician Billing Service will also receive an explanation of benefits (EOB) from your insurance company stating the claim has been denied. We will reflect this information on your account and a bill will be sent to you requesting payment in full.

12. Why do you need my insurance card?

Your insurance card indicates the billing name of the insured, but also provides other critical data for billing purposes such as: policy number, group number, plan codes, effective dates, co-pays, deductibles, referral/authorization information, physician phone numbers, insurance company phone numbers and other important information. These cards help our staff to identify your coverage, since many insurance companies offer different types of plans.

13. What is a contractual allowance?

Insurance carriers negotiate discounts from the provider charges. The amount of the discount is specific to each carrier. When the carrier pays their portion, the contractual allowance is deducted to reflect the true amount due from the patient.

14. Should I bring my insurance card with me to my visit?

Yes, the information on your insurance card is needed for the provider to file a claim with your insurance company or companies. When you register we will ask for information about your insurance coverage and have you sign a few forms. This registration process goes much faster when you bring your insurance information with you.

15. Will you accept my insurance?

WellSpan Health accepts Medicare, Medicaid, Blue Cross and Blue Shield, in addition to several other major insurance carriers. Please contact your insurance company or employer for specific list of participating physicians. For a detailed list of the plans WellSpan accepts, click here.

16. What is "coordination of benefits"?

Under a provision called coordination of benefits, a medical facility is obligated to bill the insurance that would be considered primary for you. Coordination of benefits represents the amount payable by a supplemental insurance a patient carries.

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 Medicare FAQs

 1. I have health insurance in addition to Medicare. Will you bill the other insurance company also?

If you have given us information about your additional health insurance, we will bill that insurance company after Medicare makes their payment.

2. Why do I have to give you information about other insurances if I have Medicare coverage?

Medicare requires us to bill any insurance company that could have responsibility for your expenses before we bill Medicare. In fact, Medicare will not allow us to file claims until the other insurer has denied claims. In certain situations, we must consider the possibility that another party may be responsible for your expenses before we bill Medicare. For example, if you were injured in a car accident, at your work site or on someone else's property, it is our responsibility to make sure those claims are filed appropriately. Consequently, we need to have complete information about all insurance coverage you have.

3. What is the Medicare Explanation of Benefits form?

The Explanation of Benefits form is an information document that Medicare sends to you after if has processed your medical claims. The Explanation of Benefits form provides you with information about the payment status of your bill.

4. What is the difference between Part A and Part B Explanation of Benefits forms?

Part A covers inpatient hospitalization and Part B covers outpatient and physician services.

5. What is my Medicare deductible?

Click here for a detailed answer on the Medicare website.

6. What should I do with my Explanation of Benefits forms?

We recommend you keep the Explanation of Benefits forms you receive from Medicare until all your medical claims have been paid in full. If you have other health insurance in addition to Medicare coverage, your insurance company will normally require a copy of the Explanation of Benefits from you before they will pay any remaining balance on your account.

7. Should I pay the balance listed as "your total responsibility" on the EOB form?

No. This amount could change depending on your individual insurance coverage. You should wait until you receive a bill from your medical provider before making payment.

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Referral (FAQs)

Some insurance companies require you to get a referral form from your primary care provider in order to receive coverage for specialist visits or procedures. Many services also require pre-certification or authorization. Please contact your insurance company to find out is you need a referral, prior authorization or pre-certification before your appointment.

It is extremely important for you to know the requirements of your insurance company for any office visits and/or procedures. This is particularly true if you are in a managed care plan. If you have any questions regarding coverage, you can contact your insurance representative for assistance.

If your health care insurance requires a referral from your primary care physician, you are required to obtain this referral prior to arriving for a specialty physician office visit.

Please contact your primary care physician office prior to arriving for your appointment to obtain the necessary referrals

1. What is the difference between a referral and an authorization?
A referral enables your PCP to send patients to your insurance carrier's participating specialists. Referrals do not require prior approval. An authorization is required for certain procedures and hospitalization. When an authorization is requested by a physician, it is reviewed by your insurance carrier's medical teams for appropriateness.

2. When do I need a referral?
Whenever your PCP wants you to see a participating specialist, he/she will fill out a referral form. Your PCP will either mail the referral to the specialist, or you can bring it to your first appointment.

3. When can I see a provider without a referral?
Female members may self-refer to OB/GYNs for all OB/GYN related services. Members can also self-refer to a behavioral health provider by using the number on their health plan cards.

4. How do I obtain an authorization?
An authorization request is submitted by your physician to your insurance carrier for review. Most routine, non-urgent requests are processed within two working days although it may take longer depending on the information provided by your physician when the authorization is requested. Usually, requests relating to urgent conditions are processed within 24 hours, and may be phoned in by the physician's office only. Services requiring prior authorization include (but are not limited to) durable medical equipment (DME), in-patient hospital stays, outpatient surgeries, MRIs, CAT Scans, chemotherapy, and radiation therapy.

5. How do I appeal an authorization that has been denied?
You can appeal any denial determination directly to your health plan. All appeal information is included in the denial notice sent to you and your physician.

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