Frequently Asked Questions and Answers about Statements
I am covered under a HMO, why am I getting a bill?
Even though most services are covered under an HMO plan, there may be some services that are not covered. Each health plan can verify which services are covered. It is the responsibility of the member to understand their benefits.
I paid my co-pay at the time of my visit, why did I receive a statement in the mail requesting payment?
A statement may be generated before the co-pay is posted to the patient’s account.
Why didn’t my physician advise me that my physical would not be covered under my insurance plan?
Since there are several different types of health plans with different coverage, the physicians have no way of knowing each patient’s coverage ahead of time. It is the member’s responsibility to verify their coverage for annual physicals. Most insurance plans will not cover sports, school, DMV or employment physicals. You will be billed after the visit for any charges that are not covered by your insurance.
Why does it take so long to receive a statement from San Bernardino Medical Group?
If a patient is covered under an insurance plan, a claim is generated within a few weeks of the time the medical services were received. Claims are sent either electronically or by paper, depending on the capabilities of the insurance plan. Claims sent electronically will usually be paid within a 30 day time period. Claims sent via paper will usually take over 45 days before they will be paid.
If a patient has a secondary insurance, the secondary insurance cannot be billed until the primary insurance pays their portion. A claim form is then generated, the Explanation of Benefits from the primary insurance is attached to the secondary claim, and the claim is sent, via paper, to the secondary insurance. It can take up to 90 days before the secondary insurance pays the balance of the claim.
If there is a portion left over that is the responsibility of the patient, a statement is generated. This could be 6 months to 9 months before all of the above activity is completed.
Why can’t the Billing Office change my diagnosis so my insurance plan will pay for the service?
Only physicians can diagnose patients. It is illegal to create a diagnosis just to satisfy an insurance company.
Why did I receive a bill for a co-pay for my x-ray services?
Many health plans have a separate co-pay for services such as x-ray and laboratory testing. The benefit information from your health plan should inform you if your coverage requires a co-pay for these services. If you were billed by San Bernardino Medical Group and your health plan does not require a separate co-pay for your ancillary services, contact your insurance company to have the claim reprocessed.
Why does my statement, at the bottom, show an unapplied or prepayment?
The patient accounting system is defined as a line item system. All charges are detailed out and all payments are applied against individual charges. When a payment has been received and no charge has yet been posted, that payment will show as either prepayment or an unapplied payment. When the appropriate charge is posted to your account, the prepayment or unapplied payment will be matched to the charge.
What is my deductible?
Your health plan will tell you the amount of your deductible. You can call the number on your insurance card and they will be able to advise you of your deductible. They can also tell you if you have satisfied your deductible for the calendar year.
Why was I billed for my newborn’s charges?
No insurance will add your newborn automatically. It is your responsibility to inform your insurance company to add your newborn baby. Most insurance companies will give you 30 days after the arrival of your newborn to add them to your coverage. However, not all plans will retro your coverage back to the birth. Always check with your insurance company for their requirements.
The Billing Department (PPO) or Claims Department (HMO) can help you with any questions you have about statements, billing or insurances.
Billing Department: 909-883-8611, Ext. 15015
Claims Department: 909-883-8611, Ext. 15027
Patients are required to pay for services when they are rendered. We accept cash, check, Visa or Mastercard.
San Bernardino Medical Group will bill your insurance company and is contracted with several managed care plans, preferred and exclusive provider organizations, and private insurances. You are responsible at the time of the visit for any deductible, copayment or charges not covered by your insurance company.
At the end of every month, statements are generated for all accounts with a balance. This will show any charges processed by your insurance company. Payment for your portion is due within fourteen (14) days of the statement date.
It is your responsibility to notify us of any changes to your health plan or coverage. It is also important to notify us of any changes to your address, telephone numbers, e-mail address or employment.