1) What is an estimate, and what am I supposed to do with it? Your insurance created an online tool that allows health care providers to obtain estimates of payment and patient responsibility before or at the time services are performed. The estimate is supplies negotiated discounts for services, along with any copayment, deductible and coinsurance amount(s) you will be responsible to pay. You can compare the estimate with your EOB after the claim is processed.
2) How is this estimate going to affect me? Because the estimate gives our office a more accurate way to determine your responsibility amount(s), we’re asking you to pay this amount at the time of your visit. Also, knowing up front how much out-of-pocket cost(s) you will spend helps you: - Better budget your health-related finances - Eliminate surprises when you get your EOB from your insurance company - Be a more informed health care consumer
3) Are you allowed to ask me for payment before submitting a claim to my insurance? Yes, according to our office policy and your insurance company’s policies, we are allowed to ask for patient out-of-pocket costs up front.
4) How accurate is the estimate? Because your insurance company processes the estimate the minute it arrives in their claims system, it is as accurate as possible. Please understand that because this is a point-in-time estimate, it may differ from the EOB you receive once the claim is formally submitted and processed.
5) How is my financial responsibility calculated by an estimate? Procedures submitted for an estimate are processed in the same way your insurance processes claims. The diagnosis, procedure codes and patient’s benefits plan, as well as any contracted pricing agreed to between your insurance and the health care provider, are all taken into consideration.
6) What happens if I overpay? The process for patient overpayment will not differ from what happens after a claim is processed and money has been collected. The provider will handle an overpayment according to office guidelines. (Some practices refund the patient, while others may carry a balance that will be applied to the next patient visit.)
7) What happens if I underpay? The process for patient underpayment will not differ from what happens today. Providers will handle an underpayment according to their office guidelines. (Some offices will expect payment as soon as you receive the EOB, while other offices will collect payment during the next visit.)
8) Can I run an estimate myself? Many insurance companies have not yet implemented a member estimator tool you can use to help determine your out-of-pocket expenses. However, you can access various cost-of-care tools on your insurance company’s secure member website. Just go online to your insurance company’s secure Member website to register or log in. The tools can help you plan for medical expenses and make more informed health care decisions.
Many insurance companies have tools that allow Members to look up: - Negotiated rates for common medical services performed by doctors and other health care professionals - Facility-specific costs for common inpatient and outpatient medical procedures - Estimated in- and out-of-network costs for medical and surgical procedures and services, medical and diagnostic tests, and more
Note: These cost-of-care tools do not take into consideration the patient’s benefits plan and out-of-pocket expenses, such as copayment(s), coinsurance and deductible amounts.
9) According to the EOB I just received, I’ve met my deductible. Why does this estimate still say I owe money toward my deductible? Estimates are based on claims and patient information in your insurance company’s system at the time the estimate is submitted. Claims from other providers might have been processed before our claim was processed.
10) Can I use my insurance company’s secure member website to see other estimates that were submitted on my behalf? No. The Cost Estimator tool is a provider tool & is not linked to your insurance company’s secure member website.
11) I have a flexible spending account or Health Reimbursement Account (HRA) with an auto-pay feature. Do I have to pay today? Doing so could cause me to overpay. To protect your privacy, your insurance company will not reveal dollar amounts available in a patient’s flexible spending account. Therefore, payments made from your flexible spending account will not display in the estimate.
Note: Rum River Counseling, Inc. has guidelines for working with patients who have flexible spending accounts with an auto-pay feature, and may delay payment collection until after spending account has processed.
12) I am enrolled in a Health Savings Account (HSA) plan and have a balance in my account. I think I’m supposed to wait for my EOB until I pay you anything -- is this true? Providers can ask for copayment, deductible or coinsurance amounts at any time. We recommend taking the following steps: - If the patient doesn’t volunteer information about being enrolled in an auto-pay feature (available funds are automatically paid when claims are processed), ask the patient if he/she has the account set up to automatically pay from his/her account when claims are received. - If the patient is enrolled in the auto-pay feature, please follow your office guidelines in working with patients who have an HSA account with an auto-pay feature. - If the patient is not enrolled in the auto-pay feature, payment must be received at the time of visit and include the options of using their HSA card, a credit card, cash or check.
Rum River Counseling Phone (763) 482-9598 Fax (612) 235-6447