Help/FAQ’s

General Questions:

Will Circle Family HealthCare Network send my bill to my insurance company or will I have to do that? 

 As a courtesy to our patients, we will bill all insurance plan provided to us. If you receive any correspondence from us that does not accurately reflect your insurance information, you should contact our office immediately so that we can update our records and submit claims on your behalf

  When do I become responsible for my bill?

 You are legally responsible for your bill at the time the service is provided. You are ultimately responsible       for ensuring that the Clinic is reimbursed for the services provided to you. 

When will I receive a bill?

A statement is not generated until all of your insurance companies have responded or made payments. Generally, it takes 45 to 60 days to obtain payment from your insurance carrier, but in extreme cases, it may take up to a year for their response. We do our best to work with the various insurance payers to receive payment prior to billing you. You will not receive a bill until:

Your insurance company denies the claim 

Your insurance company pays the claim, leaving a co-insurance, deductible or non-covered services 

Your insurance company fails to respond to the claim 

Will I receive an itemized statement?

 Each month you will receive a monthly statement for services which is due payable within 30 days. You may request an estimated list of current charges. However, this may not reflect a final list because many departments that helped care for you may take up to two days to submit their charges. If you wish to obtain a copy of a final itemized statement of charges, you may call our Patient Financial Services Department.

 How do I know the amount you are billing me is the correct amount?

Once your insurance carrier pays their portion of the bill, they will send you an explanation of benefits (EOB) to show how the claim was paid. You can compare your EOB to the statement sent by the Patient Financial Services Department. How the carrier paid the claim is based on their contract with us as well as their contract with you.

Why didn’t my insurance pay?

One or more of the following may apply: 

The medical attention you received was not covered under your plan. 

Your medical situation may not have met your insurance company’s definition of “medical necessity.” 

Often the insurance company will cite a “non-emergent condition” as a reason for not paying. Your EOB should provide more specific answers to this question. 

The insurance information recorded at the time of service was inaccurate, incomplete or outdated. 

You were not covered by your insurance plan at time of service. 

Your primary care physician did not process a referral for the services or an authorization was not obtained prior to the services being rendered. 

Service received was from a physician/facility outside your plan’s network. 

What is a co-payment?

A co-payment is a set fee the member pays to providers at the time service is rendered. Co-pays are applied to office visits, etc. The fees are usually minimal. The patient should be aware of the co-payment amounts prior to service.

What is a deductible? 

Deductibles are provisions that require the member to accumulate a specific dollar amount of medical bills before benefits are paid. Once the patient has met their deductible, the insurance usually pays a percentage of the remaining bill or bills. The patient is liable for the unpaid percentage. Deductibles are reset annually, usually starting in January.

What is co-insurance?

Co-insurance is a form of cost sharing. After your deductible has been met, your insurance plan will begin paying a percentage of your bills, The remaining amount, known as co-insurance, is the portion due by the patient.