Insurance & Billing
Payment Policy
Patients are required to pay for services when they are rendered.
Oaks Internal Medicine will bill your insurance company and is contracted with Preferred and Exclusive Provider organizations, and private insurances. You are responsible at the time of the visit for any deductible, co-payment or charges not covered by your insurance company.
Statements are generated for all accounts with a balance. This will show any charges processed by your insurance company. Payment for your portion is due within fourteen (14) days of the statement date.
It is your responsibility to notify us of any changes to your health plan or coverage. It is also important to notify us of any changes to your address, telephone numbers, e-mail address or employment.
Insurance Guide
Oaks Internal Medicine accepts most major insurance plans (PPOs & Medicare). We must have your current insurance information to submit claims to your insurance company. Please remember to always bring your insurance card to each visit so we can verify your insurance prior to your appointment. Benefits vary from plan to plan. Some visits, procedures or tests, may not be covered by your insurance. Balances not paid by your insurance are your responsibility and will be billed to you in a monthly statement. Please contact your insurance company for benefit specific questions.
Medicare & PPO Insurance Plans
- Aetna
- Anthem
- Blue Shield
- Health Net
- Blue Cross & Blue Shield
- United Healthcare
- Cigna
- Medicare Assignment
- Other PPO Plans
FAQ's
I am covered under a PPO Insurance Plan / Medicare, why am I getting a bill?
Services are covered under an PPO plan, but typically these services have a co-pay component, deductible and/or co-insurance which the patient is responsible for and there may be some services that are not covered. Each health plan can verify which services are covered. It is the responsibility of the member to understand their benefits.
I paid my co-pay at the time of my visit, why did I receive a statement in the mail requesting payment?
A statement may be generated before the co-pay is posted to the patient's account.
Why didn't my physician advise me that my physical would not be covered under my insurance plan?
Since there are several different types of health plans with different coverage, the physicians have no way of knowing each patient’s coverage ahead of time. It is the member’s responsibility to verify their coverage for annual physicals. Most insurance plans will not cover sports, school, DMV or employment physicals. You will be billed after the visit for any charges that are not covered by your insurance.
Why does it take so long to receive a statement from Oaks Internal Medicine?
If a patient is covered under an insurance plan, a claim is generated within a few weeks of the time the medical services were received. Claims are sent either electronically or by paper, depending on the capabilities of the insurance plan. Claims sent electronically will usually be paid within a 30 day time period. Claims sent via paper will usually take over 45 days before they will be paid.
If a patient has a secondary insurance, the secondary insurance cannot be billed until the primary insurance pays their portion. A claim form is then generated, the Explanation of Benefits from the primary insurance is attached to the secondary claim, and the claim is sent, via paper, to the secondary insurance. It can take up to 90 days before the secondary insurance pays the balance of the claim.
If there is a portion left over that is the responsibility of the patient, a statement is generated. This could be 6 months to 9 months before all of the above activity is completed.
Why can't the Billing Office change my diagnosis so my insurance plan will pay for the service?
Only physicians can diagnose patients. It is illegal to create a diagnosis just to satisfy an insurance company.
Why did I receive a bill for a co-pay for my Procedure, X-Ray or Laboratory Testing?
Many health plans have a separate co-pay for services such procedure, as x-ray and laboratory testing. The benefit information from your health plan should inform you if your coverage requires a co-pay for these services. If you were billed by OIM and your health plan does not require a separate co-pay for your ancillary services, contact your insurance company to have the claim reprocessed.
What is my deductible?
Your health plan will tell you the amount of your deductible. You can call the number on your insurance card and they will be able to advise you of your deductible. They can also tell you if you have satisfied your deductible for the calendar year.