Why am I receiving a bill when I already paid my co-pay at the time of service?
At the time of service, your ER co-pay was collected. We then filed with your insurance for your emergency room benefits. The balance due represents your deductible/coinsurance/out of pocket expenses.
What is a deductible?
A deductible is the amount you must pay out-of-pocket for expenses before your insurance company will begin to cover your medical bills. Typically, the deductible starts over at the beginning of the calendar year and each family member must meet their own deductible.
What is Coinsurance?
Coinsurance is your share of the costs of a health care service. It’s usually figured as a percentage of the amount we allow to be charged for services. You began paying coinsurance after you’ve met your deductible.
Would I be able to receive additional discounts on my bill?
If the patient responsibility was left towards your benefits, I.E. deductible, coinsurance, or you out of pocket expenses, the account would not be eligible for a discount. This would cause a breach of your benefits with your insurance company.
Can I pay my bill online?
Once you have received your statement in the mail, you will receive instructions on your statement for online payment. You may also call the Billing Office to make a payment over the phone free of charge.
What if I cannot pay my balance in full? Are there other options?
Yes. We currently have multiple payment plan options that you can have set up with the billing office. A down payment is required upon payment plan setup. If the patient cannot make immediate down payment, the patient can instead opt to give their credit card information that will be four consecutive drafted monthly payments to cover the entire balance.
What if the insurance company is indicating that (Facility) is Out-Of-Network?
Under federal law, it is a requirement that an emergency room visit claim should process at the emergent in-network level as long as the services provided is considered emergent regardless of the contractual status of the provider.
What if the services provided doesn’t meet the necessity criteria for emergent conditions?
The billing Department will thoroughly review patient charts to obtain an emergency diagnosis.
What happens if an emergent diagnosis could not be obtained?
The billing department will still be required to submit the billing to the insurance company. The benefit level that the claim is processed under will be solely determined by the insurance company.
What happens if the claim processed Out-Of-Network due to NON-EMERGENT?
The billing department will submit an appeal in attempt to overturn the insurance company(s) initial decision. While the patient is pending reprocessing of the claim that was processed out of network, there will be no statements submitted to the patient/balance due. The estimated time of completion can be up to 45 days depending on the insurance company’s turnaround time.
Appeal Denied. What happens next?
The patient will then be responsible for the amount set due by the insurance company however, the patient is able to contact the insurance company and directly request reconsideration.
What is balance billing?
Balance billing is a direct consequence of insurance companies failing to pay healthcare facilities anything close to reasonable amounts. When facilities are reimbursed an unusually low percentage of billed charges, they may seek to collect the remaining balance from patients.
Does Tyvan balance bill patients?
No. While Tyvan doesn’t believe in making the patient responsible for predatory underpayment by the insurance company, we request the patients become involved to mediate reasonable and fair rates requested to be paid to the facility. However, the remaining balance after the insurance company pays, is due to out of pocket expenses only, IE: deductible, co-pay, co-insurance.