HIPAA includes regulations that govern the use and release of a patient's personal health information. HIPAA also limits the kind of information providers can disclose regarding patients. For more information regarding HIPAA, please visit https://www.hhs.gov/hipaa/index.html
A monthly payment you make to an insurance carrier in order to have health insurance. Like a gym membership, you pay the premium each month, even if you don’t use it, and you will lose coverage if you fail to pay the premium.
A predetermined rate you pay out-of-pocket for health care services at the time of care. For example, you may have a $25 copay every time you see your primary care physician, a $10 copay for each monthly medication and a $250 copay for an emergency room visit.
The deductible is how much you pay out-of-pocket before your health insurance starts to cover a larger portion of your bills. In general, if you have a $1,000 deductible, you must pay $1,000 for your own care out-of-pocket before your insurer starts covering a higher portion of costs. The deductible resets yearly.
Coinsurance is a percentage of a medical charge that you pay, with the rest paid by your health insurance plan, that typically applies after your deductible has been met. For example, if you have a 20% coinsurance, you pay 20% of each medical bill, and your health insurance will cover 80%.
The most you could have to pay in one year, out of pocket, for your health care before your insurance covers 100% of the bill.
The group of doctors and providers who agree to accept your health insurance. Health insurers negotiate lower rates for care with the doctors, hospitals and clinics that are in their networks.
A provider your insurance plan has not negotiated a discounted rate with. If you get care from an out-of-network provider, you may have to pay the entire bill yourself, or just a portion, as indicated in your insurance policy summary.
A provider who has agreed to work with your insurance plan. When you go in-network, your bills will typically be cheaper, and the costs will count toward your deductible and out-of-pocket maximum.
Tribal Diagnostics can only quote benefit information as it appears at the time of verification. Depending on your services, your insurance liabilities may change based on the processing of claims. Any information Tribal Diagnostics obtains is provided by your insurance carrier. If you are quoted benefits that seem inaccurate, please reach out to your insurer and communicate that feedback to our billing department.
If you feel we have billed your active insurance benefits inaccurately, please refer to your explanation of benefits for more information. If after review, you still believe an error occurred, please contact customer service at 833-784-0944.
We agree to bill claims directly to your insurance carrier in a timely fashion and we are available to answer questions you may have regarding any billing done on your behalf. You are responsible for knowing the terms and conditions of your insurance policy. We may verify your insurance benefits or submit your claim to your insurance carrier as a courtesy to you; however, any information we may provide to you regarding your insurance benefits is an estimate only, and your patient responsibility may change based upon your insurance carrier’s processing of claims. Your out-of-pocket responsibility is a contractual obligation between you and your insurance carrier we are not able to modify these obligations. You agree to facilitate payment of claims by contacting your insurance carrier when necessary. If applicable, we will bill your secondary or supplemental insurance carrier as a courtesy to you. Billing your secondary or supplemental insurance carrier does not necessarily ensure payment by the insurance carrier nor does it release you from your financial obligation to pay any unpaid balance. In case of a partial insurance payment, you are responsible for the balance. Health insurance is a contract between you and your insurance carrier, and it is your insurance carrier that makes the final determination of your eligibility and benefits. Some costs and services may not be covered by secondary or supplemental insurance. If any claim is denied by any insurance carrier upon processing, the unpaid balance will be your responsibility. The billing department bills claims to your insurer after service delivery has occurred. Bills are transmitted and received based on HIPAA regulations to protect your privacy. If any discrepancy occurs the billing team will work to resolve these issues internally without notifying you. If your insurer denies any claims based on client action, we will then bill you for the reasonable indicated liabilities.
Your statement will show any recent transactions posted to your account in detail. This includes your dates of service, charges, payments made by your insurance (if applicable), adjustments, and patient payments. You can refer to your insurance explanation of benefits for more insurance information. The statement will provide you with your full balance for services incurred, current transaction detail, and aged balances detailed on prior statements. Some balances will be an estimate of your liability provided to us by your insurer, if your claims have not yet processed and are subject to change.
If you believe you have paid a liability in error or your insurance company has indicated otherwise, please contact customer service at 833-784-0944 for review of your account. Tribal Diagnostics also reviews balances internally and will issue refunds which are due as they are identified.
EOB stands for Explanation of Benefits and refers to the documents you receive from your insurer to explain services that have been billed, processed for payment, or denied, along with the reasons for these transactions and application to your specific benefits. You should retain these documents for your records. A remittance is what your provider receives as a confirmation of a processed payment, or denial along with reasons for these transactions. We retain these records and take action on your account both internally and externally based on the explanation given. We will only bill clients for insurance indicated liabilities. Your statement should reflect the same transactions of the EOB and remittance once insurance has processed.
Please contact customer service at 833-784-0944 and a representative will assist you. To eliminate further billing delays, we recommend that you have your insurance card present when contacting customer service.
If insurance coverage has lapsed, it is the client’s responsibility to update your care team or the billing department with these changes once new insurance is obtained. If you fail to communicate relevant changes, the billing department will notify your care team of any denials pertaining to your lapse or change in coverage or incorrect insurance information as soon as possible. Balances will be transferred to self-pay at full rates after 30 days of denial for outpatient services and 44 days for inpatient and Partial Hospitalization services.
Yes, you are liable for any balances due. It is your responsibility to provide correct billing information to your care team. Please contact customer service at 833-784-0944 and a representative will assist you with updating your demographic information.
Should collection proceedings or other legal action become necessary to collect an overdue or delinquent account, you understand that Tribal Diagnostics has the right to disclose to an outside collection agency or attorney all relevant personal and account information necessary to collect payment for services rendered. You are responsible for all costs of collection including, but not limited to: (i) any applicable late fees and charges and interest due as a result of such delinquency; (ii) all court costs and fees (but only to the extent allowed by law); and (iii) a collection fee to be charged under separate agreement with a third-party collections agency, either as a flat fee or computed as a percentage of the total balance due up to the maximum allowed by applicable law, and to be added to the outstanding balance due and owing at the time of the referral to the third party collection agency. You acknowledge that any such interest assessed on the account will be a late fee as a result of default or delinquency on your account and is not deemed interest as part of a credit transaction. If your account is referred to a collection agency, attorney, court, or the past due status is reported to a credit reporting agency, it may have an adverse effect on your credit history; and related portions of your account, including the fact that you received treatment at our offices, may become a matter of public record.