Welcome. I’m Dr Cindy Oberholtzer-Classen (my patients call me Dr. O). I’m the founder and owner of Podiatry Associates.
The past couple years have seen quite a few changes in the healthcare arena regarding billing and collections along with high deductible insurance plans.
I would like to take a moment and address many of the frequent questions and areas of confusion that we hear about in our billing department.
What is the difference between a charged amount and an allowable amount?
Charged Amount – This is the “list price” typically charged for a medical service but not the final price that you will be ask to pay for that medical service. At Podiatry Associates, we use an independent consultant to review and set those charged prices based on national averages. Those charged prices are then submitted to Medicare, Medicaid, and all commercial insurances that we do business with.
Allowable Amount – Medicare, Medicaid, and all commercial insurances have an allowable amount which is a set contracted amount with individual medical practices and medical providers. This is a portion of the “charged amount” that the insurance companies will pay for each medical service. Allowable charges are different for each insurance carrier and can vary between individual insurance companies insured through the same insurance plan.
Co-Pay – This is the amount that Medicare, Medicaid, and commercial insurances require the patient to pay on their office visit as part of their individual plans. We as a medical practice are required to collect that copay before your office visit starts.
High Deductible Plans – We have seen deductibles increase significantly the past five years and some families now have deductibles as high as $5,000 to $10,000 per year. It is important to know that you as the patient are to pay 100% of your family or individual deductible before your insurance will make a payment on your behalf.
Another important topic is the responsibility to verify covered services and medical providers approved by your insurance plan.
Ultimately it is the patient’s responsibility to confirm and know which doctors and services are covered by your health plans. These plans are not the same nationwide and coverage can even vary by patient’s individual employer’s. We will do our best to help in the benefit and precertification process but as the patient you are ultimately responsible. To help us provide and obtain more accurate information about your plan, please bring your insurance card and a valid government-issued ID to your appointment.
I hope this clears up some of the common questions we get in billing. If you have any further questions, please call our main number at 303-805-5156 and ask for a representative in our billing department.