Help! Why Do I Have a Charge For That Visit?

While having medical insurance does much to decrease the out-of-pocket costs for health care for your child, there will be still be times (unfortunately) when you will have to ‘shell out’ for care that your child receives. Our Billing department gets a lot of questions about this issue; here are the most common reasons for a charge for medical care for your child.

  1. The co-pay. Many insurances are now no longer requiring a co-pay for preventive care, which is great news. However, for visits other than check-ups, most insurances will still require you to pay a co-pay. These are always due at the time of visit. You may use cash, checks, or a credit card. By contractual agreement with the insurance company, we are not allowed to waive the co-pay.
  2. Your insurance has a deductible. If your insurance has, for example, a $500 deductible for the year, and you have not yet ‘met’ the deductible, your insurance will consider all of the charges for the visit to be your responsibility, and there will be a charge to your account.
  3. Your insurance pays for part of a visit, but not all. Some insurances will pay, for example, 80% of office charges, leaving the remaining 20% as patient responsibility. Just like a co-pay, this is part of our contractual obligation and we are not allowed to waive it.
  4. The service itself is not considered covered. This is becoming more rare in primary care, but still occasionally happens. Some insurances, especially those with low monthly premiums, have significant lists of exclusions. We aren’t able to keep track of all of these. If a service isn’t covered then we will have to bill you for it. Read through all of your insurance information carefully to avoid surprises like this. Better yet, if you have a choice in your insurance, compare the plans carefully; cheaper is not always better in the long run.
  5. You don’t have insurance for your child. This seems obvious, but parents are often surprised to hear that we can’t see their children for free because of a lack of insurance. We are dependent on the fees we receive in order to stay in business. We are a traditional for-profit business, which means we don’t receive federal or state funding for our clinic, nor do we receive donations. If you don’t have insurance, you may want to think about going to a Federally Qualified Health Center; these clinics do receive public and private money and can offer low-cost or no-cost care.
  6. Your child’s insurance wasn’t valid. We depend upon you to give us the correct insurance information and to keep us updated of any changes. If you don’t tell us of an insurance change then it’s likely that we will bill the old insurance. This will result in a rejection of the claim and a charge on your account. If you get us the correct information we can resubmit the claim to the proper payor, but in the meantime you will be responsible for all of the charges.

Please feel free to contact our Billing Office any time if you have questions about the fine points of the billing process.