Billing & Insurance
At your first visit, our front desk will make a copy of your insurance card to keep in your file. Please make sure that you have your insurance card with you at your visit. If you are a returning patient and have new insurance, please present your card so we can update your file and send the claims to the correct insurance company.
Referrals and Authorization
Certain insurance plans have provisions that require patients to obtain referrals when specialty care is needed. These referrals can be obtained from your PCP (Primary Care Physician). Since insurance companies will not pay for services without the required referral, OSMS requires a physical referral to be provided at the time of service, prior to treatment. Our Front Office staff can assist you with contacting your PCP to acquire the referral. If the referral can not be obtained by your appointment time, we can assess our schedules and reschedule you for the physician’s next available opening. We can also offer you the Maryland's Voluntary Waiver of HMO Benefits form. This form acknowledges you are waiving your insurance and you agree to assume responsibility for payment in full of the bill. Our Pre-Registration department will also gladly educate you further on your plan requirements should you have any questions.
Authorization may also need to obtained, pursuant of your insurance guidelines. Often times, physical and occupational therapies, durable medical equipment, injectables and diagnostic tests may require certain authorizations prior to performing the service. As a courtesy to you, our staff is happy to acquire the necessary authorizations through your insurance.
The deductible is the covered expense that the insured and each dependent must pay before the insurance will make a payment.
- Do you know what your annual deductible is?
- Do you know what your insurance company considers a calendar or plan year?
Example: Jan 1- Dec 31 or July 1-June 30
If you do not understand your yearly deductible, you should speak with a representative from your insurance company and have him explain this in greater detail.
Our practice’s Pre-Registration department will verify your insurance prior to your visit and are able to assess whether you have satisfied your deductible portion for the year. If you have not, our office does require you to make a deductible deposit (in lieu of your copay) towards your office visit and any scheduled surgical procedures. While we still bill your claims to the insurance company, the entire portion that insurance would have paid will be your responsibility until your deductible is met. Although the deductible deposit will be applied to your balance, the deposit we require is often times well below the insurance’s allowed amount and you may still receive a statement for the remaining balances.
Keep in mind: you effectively do not have a copay until you’ve satisfied you calendar/fiscal year deductible.
Insurances Plans OSMS Accepts
Aetna Plans PPO/ HMO/ POS
BCBS Federal Employee Program (FEP)
Carefirst BCBS (of Maryland)
Carefirst BCBS (of DC) Federal
Johns Hopkins-Priority partners/EHP/USFHP
Maryland State Medical Assistance
Medicare B / Railroad
Tricare - Federal HealthNet
United Healthcare PPO/HMO/POS/Community Plan
If your insurance is a HMO or PPO you may have a copay amount listed on the front of your insurance card. When you visit a physician listed in your insurance company's preferred provider network, you are responsible for the copay amount at the time of the office visit (if you have met your deductible). If you have not satisfied your deductible, our office will collect a deposit in lieu of your copay, which will be applied to your balance.
We often receive calls from patients informing us that they received a statement from our office. The patient states that there must be an error in our billing because he paid his copay at the time of the visit. The following list includes just a few reasons that you may be responsible for more than your copay amount. We hope that you find this helpful.
- What is your deductible amount? Have you met it? What costs or services are applied to the deductible?
- Are x-rays or additional procedures (injections, fracture care, etc.) covered with the copay amount if they are performed on the same day?
- Your insurance may state you are responsible for additional responsibility in addition to your copay.
- Check to see if your plan has exclusions. Your insurance will not pay for items that have been excluded from the plan or may not be a covered benefit under your specific policy. You would then be held responsible for payment.
- Your insurance company requires that we bill our fracture services using a coding system known as CPT (Current Procedural Terminology); these codes are found in the “surgery” section of the CPT codebook. Clearly, this does not mean that you had an operation. The fracture care services rendered in the office may be shown on your Explanation of Benefits (EOB) form as a surgical procedure. As such, your insurance company may apply a surgical co-insurance responsibility or deductible. Please know that we have correctly performed and documented the services as required by CPT coding guidelines.
We urge you to review your insurance policy book. If you have any questions concerning coverage, contact your insurance company. By understanding your insurance coverage you could save yourself time and money.
Motor Vehicle (MVA) or Workman’s Compensation (WC) Injuries
If you are involved in a car accident, you will be asked to furnish your Motor Vehicle information to our practice. We will not accept third party Motor Vehicle information. Claims must be filed through your personal Motor Vehicle carrier.
If you are involved in a work related injury, you will be asked to furnish Workman’s Compensation information to our practice.
We require the following information to submit a claim:
- Name of Motor Vehicle or Workman’s Comp carrier
- Address of the MVA or WC insurance carrier (this is not the same as the employer’s address)
- Claim Number
- Date of Injury
- Case/Claim Adjuster’s Name and Phone Number
In both cases, we will not submit claims to your private health insurance unless your Motor Vehicle Personal Injury Protection (PIP) exhausts or your Workman’s Comp claims are denied. If you cannot furnish our practice with the required information or you disclose that you will not be filing a claim with your carrier, we can offer you a self pay option of which payment is due at the time of service. You may also contact your private health insurance directly and inform them that you were in a car or work accident, but have chosen to waive your Motor Vehicle or Workman’s Comp coverage. They may grant you a special authorization that will allow us to bill your services to them in lieu of your Motor Vehicle and Workman’s Comp carriers. We will require a letter from your insurance validating this authorization. We will be unable to submit claims to your private health insurance without this authorization.
Reviewing Your Statement
When you receive a bill from our office you should review it thoroughly. If you find something on your bill that you do not understand you should contact our billing department (billing@OSMC.net). The billing team will be able to explain the charges to you.
The following list will give you a few ideas of what you should look for on your bill.
- Make sure the dates on your bill match the dates that the physician saw you.
- Check to see what you were billed for at each visit.
- Check to see if your insurance company paid and if the correct amount was credited to your bill.
- Make sure that personal payments have been credited to your account.
Understanding Your Explanation of Benefits (EOB)
Your insurance company should send you an Explanation of Benefits after consideration of each medical claim. Understanding your EOB will help you make sure that your insurance company has paid correctly. The following items are typically what you would find on your EOB:
Date of Service - This is the date you were seen by your physician.
Billed Amount - This is our office charge for services.
Allowed Amount - This is the amount of which your insurance company’s contracted fee schedule deems an eligible payment amount for services rendered.
Not Covered - This is the amount that exceeds the insurance company’s contracted fee schedule (the difference between our billed amount and their allowed amount). Neither you or your insurance company are responsible to pay this portion of the charge unless we are non-participating with your insurance. If we are non-participating, the patient will be responsible for this portion.
Payable Amount - This is the amount that your insurance company has paid for your service.
Deductible - This is the dollar amount that was applied toward your annual deductible.
Patient Co-Pay /Coinsurance - This is the amount you would pay if your plan requires a co-pay or coinsurance for services.
We appreciate that you chose our practice to provide excellent service and quality medical care for you and your family. We gladly welcome any further questions or comments that you may have. Thank you!
OSMS’s Billing Team
Email Us: Billing@OSMC.net
Call Us: 667-204-7000