Insurance Coverage

Frequently Asked QuestionsInsurance Coverage

• • How do you handle Non-Payments from a patient?

    We understand that patients can have financial hardships, so we offer programs like Care Credit to help get them more time. However, we cannot hold onto the debt for long as medical practices do not generally engage in the collections process past a certain time. We will generally attempt to send three statements, make a follow-up phone call and send an email if it’s on file. After 120 days, we will recommend that the account be turned over to pre-collections where attempts to make arrangements will again be attempted. After that, the billings go to a collection agency. This is a last resort for us and we do all we can to avoid this by communicating with the patient prior, if they are available.

  • How do you handle Non-Payments from an insurance carrier?

    We must first determine if the denial, whether in part or in full, is valid. If the denial is not valid, we will request the payer to reprocess the claim. For instance, if the denial is for the wrong diagnosis code or modifier, we will correct and rebill the claim. If the denial is for medical necessity, we will send the medical records and appeal if needed. Depending on the payer, we may file multiple appeals, including administrative appeal, and follow-up until the claim is paid or we receive a decision in writing otherwise. Unfortunately, this is part of the process as insurance companies occasionally deny payment even after providing a valid pre-authorization. This can lead to months or even years of appeals to obtain the appropriate reimbursement.

  • What does “in-network” and “out of network” mean?

    If you receive your health care services from a hospital, physician or other health provider that participates in your health plan, they are considered "in-network." Hospitals, physicians or other health care providers who do not participate in your health plan may be referred to as "out-of-network." You may have a higher co-insurance and/or co-pay for out-of-network services. In some cases, out-of-network services are denied totally. We strive to be in-network for nearly all the insurance providers in our region.  However, its impossible to contract with them all. It is best to determine if the providers are in network or out of network by calling your insurance company in advance.

  • Do you offer payment arrangements?

    Most medical practices are not set up to provide such services. All standard forms of payment are accepted, including cash, check, and major credit cards including Care Credit. In rare cases, we can offer payment arrangements for some patients with hardship exceptions, which are determined by our management team.

  • Why am I getting a bill now when services were provided so long ago?

    Inovia Vein Specialty Centers will process and send a bill to a patient after payment is received from the insurance carrier and the balance owed by the patient is confirmed. The length of this process depends on how long it takes to receive a response from your insurance carrier; if the claim has been delayed by the insurance company or ends up in an appeal, it can take a long time. Also, timing depends on whether there is secondary insurance. That can add time to the claims process as well.  If there is ever a question on why it is taking so long, your insurance company can provide an explanation as well.

  • Why did I receive a bill if I have insurance coverage?

    This is dependent on your insurance plan and the benefits they provide for you. We submit a bill and there is usually a portion paid by your insurance on your behalf and a portion that is patient responsibility. You will receive a patient responsibility statement after your insurance processes your claim. The amount you are billed for is based on what your insurance communicates to us on an explanation of benefits (EOB). The EOB details how your insurance processed your claim and calculated your responsibility based on your individual insurance plan. If you believe your responsibility is not correct, please contact your insurer directly for an in-depth explanation.

  • If I have an ultrasound done at Inovia Vein Specialty Centers, what will be my portion to pay out of pocket?

    It’s most common that your ultrasound benefit will fall under x-ray diagnostic imaging. This typically applies to your deductible and coinsurance coverage. If there are any questions, is always an option to check in with your insurance company for explanations of your benefits.

  • Do you provide out of pocket costs prior to procedures?

    We strive to provide a good faith estimate of your costs prior to any procedures. Much of this is dependent on the contracts you have with your insurance plan for your coverage. We often submit a pre-authorization and once that is in, we have an experienced team that checks with your insurance company for your benefits and calls you to discuss your estimated out of pocket prior to any procedures in our office. You can also call your insurance company about questions about your out-of-pocket expenses at any time. If any codes are needed to facilitate this call, we can help provide them.

  • Will I have to pay prior to receiving services?

    Most insurance plans have co-pays that they require you to pay. Co-payments will be requested at time of service per the requirements of your insurance plan.

  • What benefit do procedures fall under with my insurance?

    It’s most common that your procedure benefit will fall under outpatient surgery done in an office setting. This typically applies to your deductible and coinsurance coverage. Unlike a hospital or surgery center, that have much higher facility fees, we do not charge for anesthesia or recovery room which is why we can provide the same services for a much lower cost for the patient.

  • Why did my insurance pay only part of my bill?

    Nearly all insurance plans require that you pay a co-payment, coinsurance or deductible for your health care expenses. This is a requirement they have of you for having their insurance. We do our best to help determine that cost, however, if you have any questions, you can always contact your insurance company for specific information about your coverage specifics with them, and we are happy to provide you the most common codes we bill.

  • Will you bill my primary and secondary insurance carriers?

    Yes, as a courtesy to our patients, Inovia Vein Specialty Centers will submit the bill to your primary insurance carrier. If you have a secondary insurance company, a claim will also be sent to the secondary insurance company after the primary insurance company processes. You are required to supply the pertinent billing information that the insurer may require. They will determine your ultimate out of pocket costs based on the plan you have with them.

  • Do I need a referral to be seen in your office?

    Generally not. However, it depends on health plan you have. Some health maintenance organizations (HMO) plans and point of service (POS) plans will require a referral before seeing a specialist. On the other hand, preferred provider organization (PPO) and exclusive provider organization (EPO) plans do not require a referral. Most commercial insurance plans and Medicare do not. If there are any questions, it is best to check with your insurance company about what they require of you before scheduling.

  • Does Medicaid cover varicose vein treatment?

    Some Medicaid programs cover varicose vein treatments and others do not. It depends on the particular plan and also the extent of the patient’s vein symptoms. Most Medicaid plans will cover the treatment of varicose veins in the presence of wounds, recurrent infections and bleeding history. Some will also cover patients with advanced skin changes. Each state has slightly different regulations as does each plan that administers Medicaid. Sometimes it’s best to be evaluated and then submit for pre-authorization from the plan administering the Medicaid program to seek clarity if possible.

  • Does Inovia Vein Specialty Centers accept Medicare?

    Yes, we do. By accepting Medicare, Inovia agrees not to bill the patient for any charges Medicare disallows. However, consistent with Medicare policies, we do bill patients for deductibles, co-insurance and non-covered services.