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Why didn't my insurance cover this?

A message appears on the statement under the description of the service that indicates the reason the service was not covered. Typical reasons for non-coverage are deductible, co-insurance, and not covered by your plan. It is your responsibility to pay the doctor for these items. In general, insurance plans do not pay for 100% of services. Contact your insurance carrier to discuss your coverage. Your benefit booklet also details your coverage for different types of services.


Did you bill my insurance?

Insurance is billed for all patients who provide information at their doctors office. Contact your insurance plan to verify that the claim was received and processed. Please contact our office only if you have verified that your claim was not received by the insurance carrier. If you do have to contact us, please confirm your insurance plan information including the plan name and address, your identification number, and group number.


Is my doctor in network?

Participation must be confirmed directly with the plan to ensure that the information is accurate. Each network has sub-networks and some are also marketed by multiple entities and names. The only way to be certain is to contact the insurance plan directly.


Which Insurance did you bill?

Contact your insurance carrier to determine if the bill was received. If not, please contact us with the correct information.


Insurance needs information from the patient

You do not have coverage for these services until you contact your plan. The patient or insured party must contact the insurance company and provide requested information.


What is co-insurance?

This is another name for copay or deductible. This is the portion that you must pay to the doctor.


Common reasons for payment denials are listed below:

Benefits Maxed:	You have reached the maximum amount your plan will pay for this year. You must pay the doctor for these services.
Deductible Applied	The patient must pay the doctor for this amount.
Ins needs info for pt	You are not covered by your health plan until you contact them and provide the information they need.
Auto Accident	Health insurance does not cover this service. You must pay the doctor for these services. You may wish to present a copy of your statement to your auto insurance agent for reimbursement.
Not Covered by Plan	Your insurance company does not pay for this service. You are responsible for payment.
Patient Coinsurance	Portion of the bill to be paid by the patient.
Pre-exist Condition	You do not have coverage for this condition. You are responsible for payment of all services related to this condition
Ins Paid Patient	The insurance company paid you rather than the doctor. You must pay the doctor immediately.
Patient Not Covered	Your insurance plan indicates that the patient is not covered by the plan. Please verify coverage. Contact us to verify that we have your current insurance information.
Coverage Terminated	Your insurance plan indicates that the patient is not covered by the plan. Please verify coverage. Contact us to verify that we have your current insurance information.