Everyone seems to have a Top Ten list and HMF is no different. Here are the answers to the questions patients ask most:

1 – Can you help me figure out my statement?

Sure. Each statement shows details related to your visit(s) for 90 days. After that, visits are recorded under “Balance Forward.” To make sure you get at least one statement with all the details of your visit, we generate a statement for you every 30 to 45 days even when we have billed your insurance and are awaiting payment.

If you ever misplace your itemized statement and need those details again, just call the HMF business office and we’ll be glad to mail or fax a printout of your account. In the meantime, we are continually upgrading our information system to make statements easier to decipher.

2 – Why hasn’t my insurance been billed?

Two to five days after your visit, we bill your insurance using information you provided us. If your information is outdated or incorrect, the insurance company will reject the claim. HMF will then mail you a statement or phone you to resolve the problem.

The easiest way to avoid rejected claims is to bring your insurance card every time you visit our office and to confirm your address and telephone number.

3 – Why am I getting a statement when I made my co-payment in the office?

Oops! When an office gets really busy, your co-payment may not get recorded correctly. Get a receipt for every co-payment, especially if you pay in cash. Should you get a statement in error, return it with a photocopy of your receipt or cancelled check and we will take care of it.

4 – You billed my insurance for something they don’t cover. Can you rebill for something they do cover?

No, because that would be insurance fraud.

HMF takes great care in charging procedure codes that are reflective of the services you received in accordance with the prescribed definitions of service as set forth by the Current Procedural Terminology (CPT) guidelines published annually by the American Medical Association. These codes represent the nationally accepted standards for determining charges.

5 – I have AARP. Can you just bill them?

Joining AARP does not automatically enroll you in their insurance program. Please confirm that you have enrolled in their plan before you list AARP as your secondary insurance.

6 – Why does my insurance company statement say these services were paid “out of network”?

There are three common reasons:

  • The HMF physician who treated you was not contracted with your insurance. We add new physicians to our existing contracts as quickly as possible, but insurance carriers don’t always move as fast. Call us and we will contact your carrier.
  • HMF was not under contract at the time of your visit. Periodically we renegotiate our contracts and some carriers let their current contract lapse during this process. If this happens, contact your carrier directly.
  • Finally, HMF may not have a contract with your insurance carrier, which means you are responsible for the total balance due. To avoid problems, call your insurance carrier (the customer service phone number is often on your insurance card) or visit their web site to verify which physicians are under contract.

    • 7 – I returned my statement with my credit card information, then received another statement. I don’t want to be billed twice. What should I do?

    If you’ve sent us your credit card information and you get another billing statement from us, do not send the information again.

    When you pay with a credit card, processing takes a little longer because paperwork is forwarded to us from our payment processing center in Ohio. We just need a little more time to process credit card payments. However, if you are ever charged twice, please call and we will credit your card.

    8 – My Medicare statement says my “deductible has been met.” Why are you asking me to pay?

    When you receive a statement from your insurance stating that a charge has either been “applied to your deductible” or that your “deductible has been met” this means that the insurance carrier has recognized the charges as applicable charges to your deductible.

    However, you are responsible for paying the deductible, then insurance takes over. For instance, if your annual deductible is $250, and our charges total $300, the insurance may recognize $250 of the $300 charge as satisfying your deductible. You pay $250, and they pay the remaining $50 plus any additional charges you incur during that year.

    9 – I’m an HMO patient. Why did I get a statement?

    You shouldn’t receive a statement unless: you didn’t pay your co-payment during your visit, you received services that the HMO does not cover, we were not your primary care physician, or we billed your plan and were informed that your plan is not responsible for the bill.

    Or, we may have you on file as a PPO patient instead of an HMO patient. Insurance cards can be unclear about the type of plan, so you could be wrongly classified in our system. If you think this is the case, return your statement with a with a copy of the front and back of your identification card and we will make the correction.

    10 – I’m a Medicare patient with secondary insurance. Why are you billing me?

    Many secondary insurance plans do not cover your Medicare deductible and some do not cover the co-pay for office visits. Please make sure you understand your coverage.

    However, when we bill Medicare, they will automatically forward their payment information to your secondary insurance along with a copy of what Medicare approved and paid—if they have your secondary insurance information on file.

    This “automatic crossover” allows your secondary to process your claim quickly and efficiently. In fact, it works so well that we often receive the secondary payment before we receive the Medicare payment on your account! However, if Medicare does not have your secondary insurance information on file, you need to send a copy of your Medicare Explanation of Medicare Benefits (EOMB) to your secondary carrier.