A medical cost can involve more than one organization. We want you to know what to ask, who may bill you, and which document answers which question before care begins.
A few specific questions can replace uncertainty with a practical next step.
Call the member-services number on your insurance card and confirm the clinician, practice, and planned service.
Ask our office what is planned and whether an exact service can be identified before the visit.
Laboratories, imaging centers, facilities, pharmacies, and other professionals may send separate charges.
These documents sound similar, but they answer different questions.
A projection based on the information available at that time. It is not a final bill or a guarantee of insurance payment.
An insurer's summary of what was billed, allowed, paid, and assigned as patient responsibility. It is not usually a bill.
A payment request from a practice, facility, laboratory, or other provider after services are delivered.
Your care may change after an examination, test result, or clinical finding. Insurance processing can also change the amount assigned to your deductible, copay, or coinsurance.
Knowing these words makes a benefits call much more useful.
A fixed amount your plan may require for a covered visit or service.
The amount you may pay for covered care before your plan begins paying under its terms.
Your percentage of an allowed amount after applicable plan rules are met.
The maximum amount your plan recognizes for a covered service under its contract.
Advance plan approval that may be required. Approval is not a guarantee of payment.
A clinician or facility without a contract with your plan, which may change your cost or coverage.
If you do not have insurance or do not plan to use it, you may have a federal right to a Good Faith Estimate for scheduled care. Our guide explains who qualifies, when an estimate is generally due, and what to do if a bill is substantially higher.
Call before your appointment with your insurance card and the planned service, if known.
(949) 720-9848 →