Urgent Care of New York Billing:
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Co-Pay : It is a payment that is specified in your insurance policy and paid by the insured person each time a medical service is accessed.
Deductible: It is the amount of expenses that must be paid out of pocket before an insurer will pay any expenses.Put plain and simple , a deductible is the amount you pay for health care services before your health insurance begins to pay.
Explanation of Benefits (EOB): is a statement sent by a health insurance company summarizing the medical services availed by the individual and the payments made by the insurance company on behalf of the insurer.EOB documents are protected health information.An EOB is not a bill.
Guarantor: Often a parent or guardian of a minor child,a guarantor on a medical form is an individual who has agreed to pay the medical service provider incase the patient is unable to make a payment or refuses payment.
Patient Responsibility / Financial Responsibility: As a patient you may have different deductibles, co-insurance, or co-payment amounts, depending on the contracted status of your insurance company. It is best to check with your service provider to assess the extent of your patient responsibilty.
Insured Member / Subscriber / Beneficiary: A person eligible for or receiving benefits under an insurance policy or plan, Medicare or Medicaid programs.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.
In-Network: If the doctor, hospital or health care facility you visit is part of your insurance company’s network, you’ll get your health care at lower prices and the provider agrees to accept your insurance payment for covered services as payment in full (minus your deductibles, co-pays, and co-insurance amounts).
Urgent Care of New York participates with many plans. Contact us or your insurance company for more details.
Out-of-Network: When a doctor, hospital, or other healthcare provider is not part of an insurance plan’s network, it is considered a Non-Participating or Out-of-Network Provider.Going out of network could mean you’ll have to pay a larger percentage of the cost or the total cost, depending on your particular plan. You may also pay a higher coinsurance percentage and have higher annual coinsurance and out-of-pocket maximums.
Statement Balance: Balance billing occurs when physicians or other providers and hospitals or facilities who are not contracted with your HMO or preferred provider benefit plan (often referred to as a “PPO”) bill you for the difference between the amount your health plan pays them and the amount the provider or facility believes to be adequate reimbursement.The most important thing you can do to prevent being balance billed is to find out in advance whether your health care providers, including hospitals, clinics, and other facilities, are contracted with your health plan. This is important because contracted providers are prohibited from balance billing you for anything over their contracted reimbursement rate for covered services and for anything other than copayments,deductibles, and coinsurance on covered services.
Pre-authorization: A prior authorization is an extra step that some insurance companies require before they decide if they want to pay for your medicine. Pre-authorizations are often needed for CT scans and MRI’s in Urgent Care treatments.It is always a good idea to contact your insurance carrier with specific questions regarding your plan and coverage.
For more information on additional health insurance terms please visit:
Please call us at (914) 741-0040 to check for insurance participation.
If you do not have health insurance you can still avail the same services. We offer discounted rates for all our diagnostic procedures and treatment to self-paying patients. Please call our office to check our special self-pay rates (914) 741-0040
Telephone: (914) 741-0040