St Augustine Medical Insurance Question & Answers | Billing FAQs - Frequently Asked Questions | Orthopaedic Associates of St. Augustine

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Medical Coverage & Insurance FAQs

FOR ADDITIONAL QUESTIONS,  YOU MAY EMAIL OUR PATIENT ACCOUNT REPRESENTATIVE.

Q: What insurance information do I need to bring with me to my first appointment?

A: Please be sure to bring a photo ID.  In addition, we will need copies of your health insurance card(s).  If you have more than one insurance plan, please bring copies of all health insurance cards with you.  Make sure you let our front office staff know which policy is your primary and which is secondary.

Q: If I am involved in an auto accident, what information do I need to bring with me to my appointment?

A: We will need a copy of your auto insurance card (even if you were not at fault in the accident).  It will be necessary for you to supply us with your active claim number.  Also, we would like to have the name and contact information for your claims adjuster for the auto insurance.  Make sure you tell our staff the exact date of the auto accident.  We will need to have your health insurance information (primary and secondary if this applies), as the auto insurance may become exhausted (all benefits used up) before we are able to file for your charges with OASA.  We will then file for these charges with your health insurance showing the auto benefits are exhausted.

Q: If I am treated in the Emergency Room or Hospital do I still need to bring my insurance information with me to my first appointment?

A: Yes, we still need to make copies of all insurances covering your hospitalization stay and treatment while there.  Even though the hospital may provide our office with your insurance information, we need to get copies of your cards for our files here at OASA.

Q: Why am I getting billed after my insurance has paid you?

A: Almost all insurance plans have either a co-payment and/or deductible that is due to be paid by the patient.  Details about the amounts of these co-pays and deductibles can be obtained from your insurance company, as they will vary from plan to plan.

Once your insurance company has paid the claim, they will send out an Explanation of Benefits (EOB) or Explanation of Remittance (EOR) to you as well as to us.  Please review and keep these EOBs as they contain very important information about how your benefits were determined and paid.  These will usually show how much money is due from you to your physician.  If your claim was denied in full the EOB will also tell you why it was denied.  Many times a simple phone call to your insurance company from you can resolve any denied claims.  The phone number to call your insurance can be found on your EOB or on your insurance card.

Q: Why did my primary and secondary insurance not cover my medical/surgical bills in full?

A: Some insurance plans have annual deductibles that must be met and sometimes these are for both insurances.  Therefore, you can have a deductible for your primary insurance and the same charge is applied to the deductible on your secondary insurance.  Again, these details will be outlined on your EOBs from each company.  Any questions you may have on your coverage and benefits can be best answered by your insurance company if the EOBs do not provide sufficient information.

Q: What does a “participating provider” mean to me?

A: A participating provider is a physician or practice that has signed an agreement with a particular insurance to provide care for patients insured by that company.  This means the physician must abide by the fees set by the insurance plus any and all rules and regulations set forth by that insurance.  In exchange for this agreement, the insurance company will list the physician and/or practice as one of their “participating providers”, encouraging their insured plan holders to visit only those providers listed.

Q: What happens if I am treated by a physician who is not a “participating provider” for my insurance company?

A: Usually the penalty for utilizing a non-participating provider ranges from an increased co-payment and/or deductible, to no coverage at all for your medical care by a non-participating provider.  Your insurance company can outline for you all the details of your plan and the benefits of utilizing participating providers with their company.

Q: How do I know my physician from OASA is a “participating provider” with my insurance company?

A: Your insurance company will have a phone number you can call to find a participating provider or you may access the insurance company’s web site to find a participating provider.  Many insurances have handbooks they give to you that will list all participating providers for the various medical specialties.  Contact your insurance company for the correct information regarding provider participation.

Q: If I do not have insurance or my insurance has left me with a large balance to pay, may I make payments on my account?

A: Since we are a medical facility, we are not set up to handle long term financing arrangements like a banking or credit card facility.  We gladly accept Master Card, Visa, American Express, and Discover credit cards and you can pay for your balances due with and of these credit cards.

We also accept CareCredit, an outside agency that specializes in convenient monthly payment plans specifically designed to pay for healthcare expenses including large deductibles or lack of insurance.  To apply for CareCredit, please visit their website at www.carecredit.com.

Q: Who should I speak with if I have questions related to my billing statement?

A: Please call 904-209-1027 to speak with our Patient Account Representative or you may email us at patientaccountrep@oastaug.com.