Insurance Lingo and Billing Stuff

Does it sometimes feel like you need a degree in insurance to even understand your statement? Think of this as a crash course to help you understand how we bill for services and what questions to ask your insurance provider.

If you feel like the most complicated part of your health care is figuring out who is paying for what part, you are not alone. Fortunately, your WHA team includes financial counselors. They can help you understand the potential WHA cost of your pregnancy, preventative care, test or procedure by giving you the information you need to follow up with your insurance company. Our billing specialists are also available by phone to answer any questions you have about your account or a statement you’ve received from WHA. We’re always here to help.

For our newly pregnant patients: Our financial counselor will meet with you at our office to review and discuss your insurance coverage any answer any questions you may have about your financial obligations during your pregnancy.

For pre-authorizations: We will contact your insurance company to obtain a pre-authorization if you are having a planned office or hospital surgery. Beyond this, it is important for you to know and understand your insurance contract and benefits. We are happy to explain general insurance terms and to help you know what questions to ask your insurance provider (including specific procedure codes, if you need them).

For patients without insurance coverage: If you do not have insurance coverage or your insurance card with you, we will need you to make financial arrangements, including a deposit on the day of your appointment. We also offer cash discounts if you pay your entire bill during your first appointment.

Paying your statement. You will receive a statement from us showing your balance after insurance payments. Your bill is due within 30 days after the billing date. For your convenience, we accept personal checks, Visa, MasterCard, American Express and Discover Card. If your insurance company has not paid within 45 days, please contact your insurance company.

Refunds. We do everything we can to identify where you may have overpaid because of new insurance, a change of insurance or a difference in the amount your insurance company ended up paying for a particular service—and to refund that amount in reasonable time frame. If you believe you have made a payment in error or have any other issues or questions related to your payment history, please contact us.

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Insurance Lingo

  • 1 Co-pay

    Co-pay

    A co-pay is the flat fee determined by your insurance company that you pay each time you receive medical care, usually between $10 and $50. Although WHA is what’s called a “specialist” practice (as opposed to primary care), co-pays are determined by your insurance company and many insurance companies require only a primary care co-pay for certain types of visits, such as women’s wellness visits. If you pay a primary care co-pay in our office when your insurance company requires a specialist co-pay, we may bill you for the difference.

  • 2 Co-insurance

    Co-insurance

    Co-insurance is the percentage of your medical bills that you have to pay, typically after you’ve paid your deductible. Usually you will be required to pay the co-insurance amount up to the point where you have satisfied your plan’s out-of-pocket maximum. If you have questions about the portion your insurance company has paid and why you owe what you do, the best answer will come from them. If you have questions about what we have charged and why, give us a call!

  • 3 Deductible

    Deductible

    A deductible is the amount you must reach before your insurance company starts paying for care. There are situations where you’ve reached your deductible but are still responsible for a portion of your bill; this could be because your insurance company applied WHA’s charge partially to the deductible, leaving you with a portion of the bills—or even if your deductible has been completely reached, you may still have a coinsurance amount until your out-of-pocket maximum is reached. If you have questions, contact your insurance company for a complete explanation.

  • 4 Women’s Wellness Visit

    Women’s Wellness Visit

    In the insurance world, a “women’s wellness visit” is one that is focused on screening and counseling to prevent illness, disease and other health problems. Many—though not all—insurance plans cover preventative health visits with no co-pays or deductibles. Some insurance companies allow you to have a women’s wellness visit up to once per year. (They can also be really picky about the timing of the visits – so make sure it’s been at least 365 days since your last one when you are scheduling.) If, at your wellness visit, you and your provider decide to get lab work or a diagnostic test, generally that is charged separately from the visit and are not included in the services your insurance company may cover as part of the wellness visit.

  • 5 Office Visit

    Office Visit

    In the insurance world, an “office visit” is one that is focused on the evaluation and management of a particular problem. Sometimes you will need an office visit following a wellness visit if you have a problem that could not be fully addressed during your wellness visit. Office visits typically require a co-pay. The charge for the office visit and any lab work or tests that are ordered will likely be applied to your deductible by your insurance company, if you have not yet met it for the year. After your deductible is met, office visits, lab work and other diagnostic tests are subject to the coinsurance required by your plan until your out-of-pocket maximum has been reached. If you have any questions, contact your insurance company!

  • 6 OB Deposit

    OB Deposit

    When you first see us during your pregnancy, we check your benefits with your insurance company. Working with them, we estimate your portion of the total cost of your provider’s charges for your pregnancy care based on your coverage and the expectation of a routine pregnancy, including a routine delivery and routine postpartum care. We will go over this estimate with you at your second or third visit. The estimated sum, called the ‘OB Deposit,’ is due at the beginning of your eighth month of pregnancy. Any balance remaining after you pay the OB deposit is billed following delivery. Lab work and ultrasounds are billed separately, as the charges are incurred, and are not part of the OB deposit. You are responsible for lab work, ultrasounds and any services outside of routine prenatal, delivery and postpartum care according to the terms of your insurance plan. If your insurance changes during your pregnancy, we will recalculate the OB Deposit.

Check Accepted
Insurance

If you’re pregnant and want to begin care at WHA–or need to schedule an appointment during your pregnancy, call us! Find a provider and location here.

Please have your insurance information handy before you begin scheduling.

This will allow our teams to check whether your plan may require a referral for the care you need or to prepare benefits information to share with you at your visit. If you do not enter insurance information when scheduling, you may be asked to pay a $200-$500 deposit before receiving service.