*Please note, this is a guide and you should contact your healthcare insurance company directly for specific details of your plan.

The following outlines our Insurance Billing Policy:

  • It is the intent of Coastal Family Urgent Care to provide quality health care in a cost-effective manner. It is our obligation to provide services, supplies or medications which are deemed medically necessary under generally accepted professional standards for your medical condition(s). Any other services or services which are not customarily covered by healthcare insurance plans will be discussed prior.
  • Your insurance policy is a contract between you and your insurance company, and we encourage patients to understand the details of their healthcare plan. While we attempt to provide the most accurate information possible, eligibility and benefits differ with each patient’s healthcare plan, and it is ultimately your responsibility to check with the insurance carrier to determine network status, coverage, and financial responsibility. You are responsible for any of the services or charges not covered.
  • Accurate insurance information with a valid photo ID is required at the time of service. If we are not able to verify/confirm eligibility, you will be charged our cash pay rate and the amount will be collected at the time of service. You will be responsible for obtaining reimbursement from your insurance company.
  • Some services may be billed separately to provide ancillary services (i.e., imaging, lab specimen processing) and all attempts will be made to utilize participating facilities. Any amounts not paid by the patient’s insurance company are your individual responsibility.
  • A piece of durable medical equipment (DME) may be provided and fitted (i.e., walker boot, crutches, etc.) to be used for a period of time to aid in your recovery. While we will bill your insurance company for these products, it will be your responsibility if they are not covered. Due to regulations, these products may not be returned.
  • Any estimated co-payment amount determined by your insurance company’s contract must be paid at the time of service. These amounts may not be waived pursuant to our contractual obligation.
  • If your insurance company has not processed your visit within sixty (60) days after proper submission of your claim, the balance may be transferred to your responsibility for payment.
  • Delinquent accounts are subject to collection at any time including at the time of service.

Why did I receive a billing statement for my office visit?

The statement received reflects the outstanding amount after submission to your healthcare insurance company. This amount is based on your plan and determined by your healthcare insurance carrier. These rates are NOT determined by our group.
If you have any questions regarding the outstanding amount, please contact your insurance company FIRST.  This number may be found on back of your healthcare insurance card or healthcare insurance website.

What is an Explanation of Benefits (EOB)?

An EOB is a document generated from your health insurance carrier describing what costs it will cover for your medical care.  It is generated when your visit is submitted as a claim for the services you received. An Explanation of Benefits is NOT a bill!
 It will show:
  • The cost of the care you received and allowed amounts
  • Any out-of-pocket medical expenses you will likely be responsible for
  • Explaination for adjustments and denials

Why does it say my deductible wasn’t met?

Your deductible is an annual amount of money that is paid out of pocket for allowed amounts for covered medical care before your health plan begins to pay.  Deductibles can be high or low, depending on the plan you have chosen, and may affect how you pay for health care costs.  Your healthcare insurance company typically won’t pay a percentage of the allowed amounts until your deductible has been met.

How do I get an itemized receipt to submit to my insurance company for reimbursement?

If you would like an itemization of charges of your visit to submit to your insurance company for reimbursement, please email your request to billing@coastalfamilyuc.com. Please note this may take up to 2 weeks after your date of service to allow for your visit to be processed.

What is the difference between in-network and out-of-network benefits?

In-network: In-network refers to providers or facilities contracted with an insurance company as part of a network of healthcare professionals a person can choose from depending on their plan. They will typically appear when searching on your insurance company’s website.
Out-of-network: Out-of-network refers to providers or facilities outside of an established network of providers contracted with an insurance company to offer patients healthcare at a discounted rate. For urgent care visits, this is typically applicable to those with HMO plans, plans assigned to an Independent Practice Association (IPA), or those who reside out of area or state.  You should review your plan prior to ensure out-of-network benefits are included.

Still not sure what to do?

If you are unable to reach your insurance carrier or you any additional questions, please email them to billing@coastalfamilyuc.com.