1. Who submits my claim to my insurance company?
Our billing is done in the office. Questions specific to billing should be directed to the office manager:
2. How is my claim submitted to my insurance company?
Vital Care submits your claim either electronically or by mail to your insurance company. Once your insurance company receives and processes the claim, they should send you and Vital Care an Explanation of Benefits (EOB). The EOB explains what was paid, denied, applied toward a deductible or due from the patient. However, an EOB is not a bill; it is merely a report of payment amounts.
I received my EOB and it says I was overpaid at my office visit. If your EOB states that you overpaid at your office visit, you are due a reimbursement. Reimbursements are processed and mailed out once a month by Vital Care.
3. I paid my copay in the office. Why am I receiving a bill for the visit?
In most cases, this means that your insurance company processed your claim towards your deductible. This should be reflected on your EOB.
4. Why do I have to pay more for urgent care than my regular physician appointment?
Typically, copays are higher for urgent care than for family practice because of the higher level of care we are equipped to provide (on site x-ray, laceration repair, etc). Similarly, ER copays are normally higher than urgent care copays because they are equipped to provide an even higher level of care (diagnostic imaging, intubation, etc).
5. Do I pay the same copay regardless of my visit reason?
Per your insurance contract, your copay is determined on where you receive services, not on your visit reason. For example, you would pay your ER copay whether you went to the ER for an ear infection or a heart attack. If you come to our office for a sore throat or a broken bone, you will pay the same copay designated for by your insurance for our office (typically an Urgent Care or Specialist copay).
6. How does the office obtain my benefits?
Our office staff verifies your benefits either online or by calling and speaking to a customer service representative. If it has been more than 30 days since your last visit, your insurance will be re-verified to ensure nothing has changed.
**While we do our best to get the most up to date and accurate benefits, we cannot guarantee the coverage details provided to us.**
We are currently awaiting review and acceptance for various insurance network provider panels in order to provide you the highest quality of care at the most affordable cost.