- What is a deductible?
- What is coinsurance?
- Can an HMO patient have coinsurance?
- Is it possible to have a deductible, co-pay, and coinsurance due for the same visit?
- What is a contractual adjustment and when is it given?
- Do services that are not covered by an insurance company receive contractual adjustments?
- Are reasonable and customary adjustments made?
- Can Kelsey-Seybold Clinic provide me a statement for my flexible spending reimbursement account?
- Why did the front desk not collect all that was due from me the day I was in the Clinic?
- Why can't the front desk not tell me exactly what my visit will cost?
- Why was I not told this service was not covered by my insurance company?
- Why did I have to pay at the Ambulatory Surgical Center (ASC)?
- Why am I receiving a bill from the Clinic for my services at the ASC, Emergency Room, or Hospital?
Q. What is a deductible? A. A deductible is the amount your insurance requires you to pay before they begin covering your medical expenses.
Q. What is coinsurance?
A. A coinsurance is your portion of your medical expenses. This amount (%) is determined by your insurance company.
Q. Can an HMO patient have coinsurance?
A. Many HMO plans now have coinsurance due on some services.
Example: A coinsurance may be due on a surgical procedure or hospital care.
Q. Is it possible to have a deductible, co-pay, and coinsurance due for the same visit?
A. Yes. The amounts due are determined by the insurance plan.
Q. What is a contractual adjustment and when is it given?
A. A contractual adjustment is an adjustment made to reduce the billed charge to the amount an insurance company has contracted with Kelsey-Seybold for a service.
Contractual adjustments are only made on services covered by a contracted insurance company.
Q. Do services that are not covered by an insurance company receive contractual adjustments?
A. No. Example: If a plan does not cover preventative care, contractual adjustments will not be applied.
Q. Are reasonable and customary adjustments made?
A. No. We do not offer reasonable and customary adjustments to insurance companies with which we are not contracted?
Q. Can Kelsey-Seybold Clinic provide me a statement for my flexible spending reimbursement account?
A. Yes. Please contact the Business Office at 713-442-5500 and ask for an itemized statement for your flexible spending account. You may specify the dates of service you need. You may also use receipts provided by the Clinic or Explanation of Benefits mailed to you by your insurance company.
Q. Why did the front desk not collect all that was due from me the day I was in the Clinic?
A. The front desk is only able to provide estimates of amounts due from patients. Even if we verify your benefits with your insurance company, they do not guarantee payment. After your insurance company processes your claim, a balance may still be due from you.
Q. Why can't the front desk not tell me exactly what my visit will cost?
A. The Clinic provides medically necessary care to our patients. The full scope of this care cannot be determined until the patient is examined by a Physician. We can upon request provide an estimate of your visit's cost. We can also provide a more detailed estimate once your doctor has prescribed medically necessary tests or procedures. You may request this estimate from the front desk before obtaining these services.
Q. Why was I not told this service was not covered by my insurance company?
A. Kelsey-Seybold Clinic will make every effort possible to verify your coverage and benefits, and inform you if we learn that a service is not covered. However, we are not always able to contact your insurance carrier before your visit. Insurance companies do not guarantee benefits; they only provide us with an estimate of the coverage available. The physicians at Kelsey-Seybold Clinic provide the care that is medically necessary for each patient; they do not provide care based on insurance coverage. Patients are encouraged to contact their insurance company with any questions about services covered or not covered by their plan.
Q. Why did I have to pay at the Ambulatory Surgical Center (ASC)?
A. Due to regulatory requirements, the ASC is a separate facility from the Clinic. They may have asked you to make a prepayment based on co-pay, coinsurance, or deductible.
Q. Why am I receiving a bill from the Clinic for my services at the ASC, Emergency Room, or Hospital?
A. The ASC, Emergency Room, or Hospital will bill you for the facility charges at their location. This statement/bill does not include the services provided by the Clinic's physicians.
