Seva Pratice Management Solutions

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Phone: (925) 634-9704
Fax: (925) 634-5757
info@sevapractice.com
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Frequently Asked Questions

Because of the complexities of the health care industry physicians will sometimes utilize a third party medical billing company to manage all the insurance and patient billing. For the most part the information about the medical billing company is invisible to you; our name does not appear on any bills and in most cases payments do not come to our office. The only time you will become aware of our presence is when you have questions. At that time, you will contact our office to answer your questions or to resolve your billing matters.

When you see a physician that utilizes Diablo Medical Billing’s services we receive all minimum necessary information from your doctor to bill your insurance or you (if you are self pay).

The insurance company processes the bill and sends the physician an Explanation of Medical Benefits (EOB) for that service. This EOB will tell Diablo Medical Billing if there is any portion of the original service that you are responsible for paying. If that is the case we will then bill the patient or the legal guardian.

The date of service is the date you saw the doctor or had a lab procedure done.

These refer to the treatment you received in the doctor’s office, hospital, or urgent care center, and may include an immunization, lab, x-ray, or exam.

You may not always recognize the physician or physician group that is listed on your bill. This is because you were seen in an emergency room or inpatient hospital by a “hospitalist.” Today, many physicians use hospitalists to care for their patients when they visit emergency rooms or are admitted to the hospital. The hospitalist communicates with your primary physician, but handles your care during time spent in the hospital.
Your insurance has processed your claim and indicates you have a financial responsibility. Some of the reasons for getting a bill may include a deductible not yet met, any co-insurance you owe, or having an unpaid co-pay at the time of visit.
You are responsible for co-insurance, co-payments, deductibles and non-covered services. Check your insurance website for details of your specific policy.
Every policy is different. Check with your carrier for details of your specific policy.
Many services are not benefits of health insurance. Some examples are: routine services, pre-existing conditions, and travel immunizations.
Our bill is for physician’s services. Example: If you had blood drawn, it is sent to the lab for testing. The lab will bill you separately.
Physician fees are standard for the practice locality.
If your insurance has processed a claim for these services, then we are billing correctly.
Yes, although, each practice has their own policies.
Discounts are determined by the physician on a case-by-case basis. It’s best to send a written request to your physician.

Contractual adjustments are the difference between what the doctor bills and what your insurance allows if your doctor is contracted with your insurance carrier.

You can find their phone number on the back of your card or on their website.

You can find their phone number on the back of your card or on their website.
Discounts are determined by the physician on a case-by-case basis. It’s best to send a written request to your physician.
Claims are billed with the diagnosis or symptom for which you sought treatment. This is provided to us by the physician, based on chart documentation.
Check your insurance carrier’s website or call the number on your card.
Sometimes statements and payments cross in the mail, or the payment has not yet been posted.
You may contact the collection agency directly. They become the owners of the debt. Their phone number is on the statement they sent you.
Payments should be sent to the address on your bill.
We bill with the information provided to the office at the time of service.
If you provided us with the insurance information, we billed your secondary insurance.
Most of our physician practices take credit cards. If your physician does not, that will be stated on your statement.
If your physician takes credit cards, we can take the payment over the phone.
Those claims have been sent to your carrier but we have not received an Explanation of Benefits (EOB). For example: Often insurance carriers will pend claims awaiting answers to a questionnaire they sent to a patient. They are usually looking for information about a pre-existing condition or other insurance information.

Helpful Terms to Know

Co-insurance
Co-insurance is the amount you are required to pay for medical care in a fee-for-service plan after you have met your deductible. The coinsurance rate is usually expressed as a percentage and depends on your plan. For example, if the insurance company pays 80% of the claim, you pay 20%.

Copay
A fixed fee that subscribers to a medical plan must pay for their use of specific medical services covered by the plan.

Deductible
The deductible refers to the amount of money that the insured would need to pay before any benefits from the health insurance policy can be used. This is usually a yearly amount so when the policy starts again, usually after a year, the deductible would be in effect again.

Explanation of Benefits
An Explanation of Benefits (EOB) is an itemized statement provided by your insurance company. It details what action your insurance company has taken on your claims. You should keep EOBs with your health insurance records for reference.

Contractual Adjustment
Contractual adjustments are the difference between what the doctor bills and what your insurance allows if your doctor is contracted with your carrier.

Procedure Code
A current Procedural Terminology (CPT) code used by a physician or other provider to describe the procedure or service rendered to the patient.

Primary and Secondary Insurance
Since many people have available medical insurance from more than one plan (such as two employed spouses covered under group health insurance plans), insurance companies do not want insureds to profit through their health insurance. To prevent double recovery, most health insurance plans have provisions which determine how primary versus secondary coverage will be determined. Primary coverage is provided through the plan of which they are a member (such as the spouses both covered through their respective employment – the primary coverage is provided under the plan provided by the employer of each spouse) or the plan under which the member has been a participant for the longest time period. Secondary coverage, usually as a result of being covered as a dependent under someone else’s health insurance plan, provides reimbursement for medical expenses after exhaustion of coverage available through the primary plan.