Understanding medical billing can be confusing, especially when you receive multiple bills or unexpected charges. At Aurora Health Care, we aim to make this process as transparent and straightforward as possible. This guide addresses common questions about medical billing, insurance, and payments to help you confidently manage your healthcare expenses. For healthcare providers aiming for efficiency and accuracy in billing, especially in fast-paced environments like immediate care clinics, consider how modern Medical Coding Software For Immediate Care can streamline operations and minimize billing discrepancies.
Decoding Multiple Bills
Receiving more than one medical bill can be puzzling. Here are a couple of reasons why this might occur:
- Family Billing Accounts: If you are responsible for the healthcare costs of multiple family members and haven’t set up a family billing account, you’ll receive separate bills for each individual. Consolidating these into a single statement simplifies management. To establish a family billing account and streamline your medical bills, please contact our Patient Contact Center at 800-326-2250. They can assist in setting up a consolidated billing system for your family’s healthcare expenses.
- Separate Service Areas: Aurora Health Care encompasses various services, including hospital, clinic, and home healthcare. If you or someone you’re responsible for receives services from both a clinic or hospital and Aurora Health at Home during the same period, each service area will generate its own billing statement. This is because these are distinct operational units with separate billing processes.
Understanding these reasons can help clarify why you might receive multiple statements and guide you in organizing your healthcare billing effectively.
Preventive Services and Unexpected Bills
It’s understandable to be surprised by a bill for preventive services, especially if you have 100% coverage. Preventive care is designed to maintain health and prevent illness, and is often fully covered by insurance plans. However, sometimes during a preventive exam, a health issue is discovered that requires further investigation or treatment. When this occurs, the nature of the service shifts from purely preventive to medical.
In such cases, the services provided become classified as diagnostic or medical in nature because they are addressing an existing or newly discovered health concern. Consequently, your insurance company processes the claim using your medical benefits rather than your preventive care benefits. This often means that services that started as preventive may incur charges if they evolve into addressing a specific medical issue. Accurate medical coding is crucial here to reflect the services provided, and in immediate care settings, software can play a vital role in ensuring correct coding even under time constraints.
Understanding Your Payment Due Date
When you have an outstanding balance after insurance processing, you will receive a billing statement. This statement will be sent either by mail or available in your account on our LiveWell app or website. The billing statement clearly indicates the due date for the full balance.
Typically, the full balance is expected to be paid on or before the date specified on your billing statement. If your statement indicates “now” as the due date, it means payment is due as soon as possible after you receive the statement and before the next billing cycle. Prompt payment ensures your account remains in good standing and helps avoid any potential late fees or collection activities. For healthcare providers, efficient billing cycles are also important, and medical coding software for immediate care can help accelerate these processes.
Credit Balances and Refunds Explained
If your account shows a credit balance, rest assured that it’s automatically reviewed by our finance team. There is no immediate action required from your side. If a refund is indeed due, a check will be automatically issued and mailed to the original payer. This could be you or your insurance provider, depending on who made the payment that resulted in the credit balance. The automated review process ensures accuracy and timely processing of refunds.
Facility Fees: What Are They?
Facility fees are charges that might appear on your bill if you receive outpatient clinic services within a hospital setting. These fees are intended to cover the operational costs associated with providing healthcare in a hospital environment. They account for the use of hospital resources such as:
- Nursing staff
- Administrative personnel
- Medical supplies
- Specialized equipment
- Infrastructure maintenance
These resources are essential for delivering comprehensive care, and the facility fee helps hospitals cover these overhead costs. It’s important to note that facility fees are separate from professional fees, which cover the services provided directly by your physician or other healthcare provider. Understanding facility fees is crucial for patients to fully grasp the components of their medical bill. For billing departments, especially in immediate care where facility fees might apply, medical coding software can help accurately categorize and bill these charges.
Observation Status vs. Inpatient Stay
It can be confusing when you stay overnight in the hospital, but your insurance processes the claim as an outpatient stay. This often happens when a doctor places a patient under “Observation status.” Observation status is a classification used when your doctor needs more time to:
- Monitor your condition closely.
- Determine if you can be safely treated as an outpatient.
- Assess if you require full inpatient admission to the hospital.
Under Medicare guidelines, doctors are typically allowed up to 48 hours for this observation period to make an informed decision about your care. If, after the overnight stay and monitoring, your doctor determines that your condition did not necessitate inpatient-level care, the stay is classified and billed as outpatient, even though it involved an overnight hospital visit. This classification is based on the intensity of services required and the medical necessity for inpatient admission.
Coding Changes and Insurance Payments
If your insurance company suggests that changing the medical coding could alter how they process your bill, it’s important to understand our coding process. At Aurora Health Care, medical coding is performed by certified coders. These professionals possess in-depth knowledge of federal and state coding regulations and guidelines. They meticulously assign the most accurate and appropriate codes for the services you receive based directly on the clinical documentation recorded during your visit.
While we are always willing to review coding to ensure it precisely matches the documented services, we cannot alter codes solely to increase insurance payment. Our priority is accurate and ethical coding that reflects the care provided. For healthcare facilities, especially busy immediate care centers, maintaining coding accuracy is paramount. Medical coding software for immediate care is designed to assist coders in selecting the most appropriate codes quickly and correctly, enhancing both compliance and revenue cycle management.
Will You Receive a Bill?
Yes, it’s likely you will receive a bill if there is a remaining balance after your insurance company has processed and paid their portion of your medical expenses. After your insurance company has paid its share, you’ll receive a statement in the mail. This statement will detail:
- The total amount billed for services.
- The amount paid by your insurance company.
- The portion that you are responsible for paying (your out-of-pocket costs).
This statement provides a clear breakdown of your financial responsibility. You can settle your medical bill through various convenient methods: in person, by mail, over the phone, or online for ease of payment.
Obtaining a Copy of Your Medical Bill
Accessing your medical bill is straightforward. You can easily find a copy of your bill in your secure LiveWell account. Alternatively, you can request a copy directly from our Patient Contact Center. By calling 800-326-2250, you can ask to receive your bill via mail, fax, or email, depending on your preference. This ensures you have convenient access to your billing information whenever you need it.
Questions About Your Bill? We’re Here to Help
If you find yourself unsure about any aspect of your medical bill, please don’t hesitate to reach out. Our dedicated Patient Contact Center is available to answer all your billing questions. You can contact them at 800-326-2250 for clear explanations and assistance in understanding your medical expenses. Clear communication is essential in healthcare billing, and for providers, especially in immediate care, having systems that produce easily understandable bills and facilitate quick responses to patient inquiries is crucial. Medical coding software for immediate care can contribute to this by ensuring accurate and transparent billing from the outset.
Possible Overpayment and Payment Status
If you believe your bill has already been paid, it’s possible that your payment and the billing statement crossed paths in the mail. To verify the status of your payment, please contact our Patient Contact Center. You can reach them by email through our website or by calling 800-326-2250. They can check your account status and provide immediate clarification. We apologize for any confusion this may cause and appreciate you bringing it to our attention. Please inform us if you receive another statement after confirming your payment.
Convenient Payment Methods
Paying your Aurora medical bill is designed to be as convenient as possible with multiple options available. In addition to in-person payments, you can choose from these easy methods:
- Online Payment: Pay securely through your LiveWell account or via our secure online bill pay portal.
- Pay by Phone: Use our automated pay-by-phone system, available 24/7, by calling 800-326-2250.
- Mail a Check: Send a check to Aurora Health Care, P.O. Box 809418, Chicago, IL 60680-9418.
These options offer flexibility to suit your preferences and ensure timely payment of your medical bills.
Accepted Payment Methods
We accommodate various payment methods for your convenience:
- Credit/Debit Cards: We accept major cards including MasterCard, Visa, Discover, and American Express. You can pay online or by phone at 800-326-2250.
- Electronic Funds Transfer (EFT): Make payments directly from your bank account through your bank’s website using Electronic Funds Transfer.
These options ensure that you can easily manage your medical payments using your preferred financial tools.
Insurance Queries
Who Is Billed For Your Visit?
To ensure accurate billing, it’s crucial to provide your health insurance information when you schedule your service. This includes details for all insurance plans you intend to use for payment. If you don’t have this information during scheduling, please provide it at check-in.
For services related to workplace injuries or illnesses, provide your employer’s name and worker’s compensation coverage details. In accident cases where a third party might be liable, we will initially bill your medical insurance, which may then coordinate with the third party for payment recovery. If you lack health insurance and a third party is potentially liable, we offer a one-time courtesy billing to the third-party insurer. However, follow-up for payment beyond this courtesy billing becomes your responsibility.
Confirming Insurance Coverage
To confirm if your insurance plan will cover your upcoming medical service, start by identifying the specific services you will receive during your visit. It’s important to know how these services will be coded and billed to your insurance company.
Request the Current Procedural Terminology (CPT) codes for these services. Once you have the CPT codes, contact your insurance company directly. Verify if your plan covers these specific services and inquire about the expected payment structure, including copays, deductibles, and coinsurance. This proactive step helps avoid unexpected out-of-pocket expenses. For providers, especially in immediate care settings dealing with various insurance plans, medical coding software can assist in quickly providing accurate CPT codes to patients for insurance verification.
Updating Insurance Information
Keeping your insurance details current with us is simple. To update or change your insurance information, just contact us at 800-326-2250 during our regular business hours. Our team will assist you in updating your records to ensure all future claims are processed correctly and without delay.
Cost Estimates Before Service
Understanding potential medical costs upfront is important. You can obtain a free cost estimate through LiveWell to see your estimated out-of-pocket expenses for both hospital and professional services. Alternatively, you can call us at 800-326-2250 for a personalized estimate.
Please remember that the final bill may vary slightly from the initial estimate. This is because the final charges are based on the actual services rendered during your treatment, which might include additional services ordered during your visit to address your specific medical needs.
Options Without Health Insurance
If you do not have health insurance coverage (no payer source like private insurance or Medicare), Aurora Health Care automatically provides a 50% discount on your medical service bill. For questions or further assistance, please call 800-326-2250 or visit our facilities to speak with a financial counselor. They can provide guidance on financial assistance programs and payment options to help manage your healthcare costs.
Disagreeing with Insurance Claim Processing
If you disagree with how your insurance company has processed your claim, the first step is to contact your insurance company directly. Initiate an appeal by following the grievance process outlined in your insurance policy. If your employer is self-insured, you can also contact your employer to begin a review process. Understanding your insurance policy’s appeal process is essential for resolving claim disputes.
Urgent Care Service Billing Differences
The billing for urgent care services can sometimes differ from your expected costs because urgent care centers may operate under different classifications. Some are hospital outpatient departments, while others are clinic-based. Your insurance company may process claims differently based on these classifications and your specific plan benefits.
We can provide your insurance company with records confirming that your service was indeed urgent care. To initiate a courtesy appeal on your behalf, contact the Patient Contact Center at 800-326-2250. They can assist in filing an appeal to ensure your claim is processed correctly based on your urgent care service.
How Urgent Care Services Are Billed
It’s important to note that urgent care visits at Aurora clinics are billed as physician office visits, not specifically as “urgent care” visits. Therefore, the term “urgent care” might not appear on your billing statement. Similarly, any copay collected at the time of your urgent care visit will be an office visit copay.
To fully understand your financial responsibilities, familiarize yourself with your insurance coverage for physician office visits. If you are unsure about your insurance handling of these claims or want to confirm your copay amount, please contact your insurance provider directly. Understanding these billing nuances helps you anticipate and manage your healthcare expenses effectively. For immediate care clinics, ensuring staff and patients understand this billing distinction is important, and medical coding software can help standardize the coding process for urgent care visits.
Checking if Your Claim Was Sent to Insurance
Please allow up to 60 days for your claim to be processed and sent to your health insurance company. If you did not provide insurance information during your visit, or if it has been over 60 days and your insurance company has no record of the bill, contact our Patient Contact Center. You can email them or call 800-326-2250 for assistance. They can track the status of your claim and ensure it is correctly submitted to your insurance provider.
Payment Information
Payment Expectations and Due Dates
When you have a balance due, you will receive a billing statement either in the mail or through your LiveWell account. The full balance is due on or before the due date listed on the statement. If the statement indicates “now” as the due date, payment is expected as soon as possible after receipt and before the next statement cycle. Timely payment is appreciated to keep your account current.
Uninsured Discount
If you lack a payer source such as private health insurance or Medicare, you are entitled to a 50% discount on your medical bills at Aurora Health Care. This discount is automatically applied to help make healthcare more affordable for uninsured patients.
Getting a Cost Estimate
Yes, you can always request a cost estimate for upcoming medical services. Contact us at 800-326-2250 to get an estimate for future procedures. The final charge will reflect the actual services provided, which may slightly differ from the initial estimate based on the treatment needed and services rendered during your visit.
Combining Accounts and Payment Arrangements
We strive to assist you in combining multiple accounts to simplify bill management and payments. However, in some specific situations, combining accounts may not be feasible due to system limitations or account types. Please contact us to discuss your specific needs, and we will do our best to accommodate you.
Full Payment Discounts
Unfortunately, we do not offer discounts for paying medical bills in full at the time of service or upon receiving the billing statement. Payment in full by the due date is expected as per our standard billing policies.
Payment Allocation Across Services
When you make a payment, it is automatically applied to the oldest outstanding service on your account. Once that service is fully paid, any remaining amount is then applied to the next oldest service with a balance. This process often results in partial payments across multiple services, which will be detailed in your billing statement for clarity.
Multiple Parties Paying Your Claim
In situations where multiple parties might contribute to paying your medical bill, such as insurance and personal payments, or in cases like child medical bills paid by multiple family members, we are here to clarify any confusion. If your account shows a credit balance due to overpayment, it is automatically reviewed by an Aurora team for refund processing. Refunds are issued to the party that overpaid, whether it’s an individual or an insurance company (upon written request from the insurer).
Financial Counseling Services
Yes, financial counseling is readily available. If you have concerns about healthcare costs or are worried about affording your medical care, our Financial Advocates are here to assist you. They can:
- Provide detailed cost estimates for upcoming services.
- Assess your eligibility for financial assistance programs.
- Discuss various payment plan options tailored to your financial situation.
Contact a Financial Advocate today by calling 800-326-2250 to explore how they can help you manage your healthcare expenses. For immediate care facilities, having clear financial counseling options and information readily available is crucial, and medical coding software can help ensure accurate cost estimates and billing information are available for counselors to use.
Medicare Claims
We gladly handle the filing of your Medicare Parts A and B and supplemental insurance claims. Medicare payments are sent directly to us. It’s important to inform Medicare of any changes to your supplemental insurance plan, as Medicare automatically forwards certain claims to your supplemental insurer. This ensures seamless processing and payment of your claims.
Setting Up a Payment Plan
We offer interest-free repayment plans to help you manage your medical balances. The duration of the plan depends on the total amount due. To avoid collection activities, it’s important to set up a payment plan within specified timeframes. Accounts not under a payment plan may proceed to external collection agencies as they age. To establish a payment plan, log into your LiveWell account or call us at 800-326-2250 to discuss available options and set up a plan that works for you.
What If You Cannot Pay Your Bill in Full?
If you are unable to pay your medical bill in full, please contact us as soon as possible. Discussing your payment options with us promptly can help prevent your account from being turned over to a collections agency. Call 800-326-2250 or access your LiveWell account to explore available payment assistance and options. If you are uninsured, you might qualify for further discounts or financial aid through our Patient Financial Assistance Program, detailed on the back of your billing statement and on our website at /patients-visitors/billing-payment/financial-assistance.
Past Due Accounts: What to Expect
We understand that managing bills can be challenging, and we aim to keep you informed about your account status. Past-due notices are clearly marked on your statements to ensure you are aware of any overdue balances. If an unpaid bill remains unresolved, we may take further steps, which include:
- Telephone contact to discuss your account.
- Requests for a face-to-face meeting to resolve billing issues.
- Sending collection letters and emails as reminders.
- Referral of your account to an external collection agency if necessary.
We encourage open communication to resolve any billing concerns before accounts become severely past due.
Payment Summaries for Taxes and FSA
We provide various payment summaries and documentation to assist you with tax filings and Flexible Spending Account (FSA) reimbursements. The types of documents available include:
- Detailed itemized bills.
- Guarantor summaries outlining all charges.
- Guarantor payment letters verifying payments made.
Learn more about obtaining these payment summaries at /patients-visitors/billing-payment/faq/payment-summaries. These documents are designed to help you efficiently manage your healthcare finances and tax obligations. For healthcare providers, especially in immediate care, ensuring that billing systems can easily generate these summaries is important for patient service and satisfaction. Medical coding software for immediate care can be integrated with billing systems to streamline this process and ensure accurate financial documentation.
