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Allure Medical Billing FAQs

What is a copay?

A copay is a flat dollar amount that is generally owed for all Office Visits. With certain insurance policies diagnostic and/or surgical procedures can be subject to a copay as well.

What is a deductible?

A deductible is the dollar amount that you (the patient) will owe each policy year before your insurance pays at any percentage.

What is coinsurance?

Coinsurance is the percentage your insurance will cover once you have met your deductible. Some policies don’t have a coinsurance. These policies pay 100% once your deductible is met.

What is the maximum out-of-pocket?

Maximum out-of-pocket is the maximum amount you will pay in a policy year before your insurance will cover you at 100%. Some policies include copays and/or deductibles in your maximum out-of-pocket and others do not. Please contact your insurance policy if you are unsure about your coverage.

What do the “Charges” on the statement mean?

A charge is the dollar amount we submit to the insurance company. Insurance companies generally approve of a smaller dollar amount than what physicians charge. The patient’s responsibility is what your insurance company approves.

What do the “Credits” on the statement mean?

A credit can be a patient payment, insurance payment or insurance adjustment. Insurance adjustments are generally made to adjust off the difference between the amount charged to insurance and the amount the insurance company approves of for that charge.
What is the difference between “Total Balance” and “Patient Balance” on the statement?

The total balance includes all charges not paid yet. This includes charges to be paid by insurance and/or patient. The patient balance is strictly what the patient owes at the time of the bill.

What does the “Insurance Pending” mean?

Insurance Pending means that the charges have been sent to insurance but they have not yet been processed. The insurance will pay and/or adjust this balance according to your cost share (deductible, coinsurance, and maximum out-of-pocket).

Why wasn’t my secondary insurance billed?

If you gave us a secondary insurance card but it was not billed, please feel free to reach out to us and we will gladly send the claim. If you did not inform us of your secondary insurance while in office, you can call us with the information of your secondary insurance, and (as long as it isn’t passed timely filing limits) we can submit the claim. Note: Secondary insurance policies may or may not cover everything the primary insurance does not. You may still get a bill once both insurance plans processed.

What if I disagree with the total patient balance on my statement?

Once your insurance company processes your claims they send us an explanation of benefits. We post this to your account according to how the insurance processed your claim (payments, deductibles, coinsurance, copays). Therefore, if you disagree with these amounts we urge you to call your insurance company. If they inform you it was an error in their processing they will reprocess the claim for you. If you have a discrepancy with the insurance policy we sent your claims to or who we listed as policyholders, please feel free to contact us.

What if I was quoted incorrect benefits?

We can only quote you the benefits that your insurance company has quoted us. We cannot guarantee the benefits that your insurance company’s online portal, automated phone system or phone representative has quoted. Please refer back to your insurance contract if you feel these benefits are incorrect.

What are diagnostics?

The leg ultrasounds we perform are diagnostic. It is a “test” that helps us diagnose and treat a patient.

What is vein surgery?

According to insurance companies, laser ablations, phlebectomies, and sclerotherapy injections are considered in office/outpatient surgery.

Why am I getting a bill when I was scheduled for a vein consult?

The consultation is free. If you are a candidate, we may offer to go forward with your Mapping the same day. The Mapping consists of your initial office visit along with a diagnostic ultrasound of your legs. This will tell us what treatment, and approximately how many treatments are needed. If you decided to stay same day for the Mapping, that would be subject to your insurance cost share.

How many vein treatments will I need?

Every patient is different but we will be able to give you an estimate once you have an ultrasound.

I thought my insurance covered these services, why am I getting a bill?

Most insurance policies consider the treatment of medically necessary varicose veins a covered benefit however, it is subject to your cost share (deductible, coinsurance, copay, and maximum out-of-pocket).

Why is my copay higher for your office than my Primary Care Physician?

We are a Specialist office and many policies have a higher copay amount for Specialists.