Insurance

If you have a question regarding insurance coverage please contact your insurance company directly by calling the number listed on the back of your insurance card. Your insurance company will be able to tell you if they cover a specific treatment or procedure.

Deductibles / Co-pays / Co-insurance Payments
Many insurance companies have amounts which the patient must pay. These are called deductible, co-pay or co-insurance payments. If your insurance plan requires you to pay a deductible and co-insurance, the balance will be billed to you. You will also be billed for any other amounts not covered by your insurance. If you have a question about why your insurance company did not pay part of a claim, you should call your health insurance company directly.

Precertifications / Prior Authorization Referrals
Many health insurance plans have precertification or prior authorization requirements for specific services. Information about these requirements is usually listed on the back of your health care insurance card. Please refer to your card, your benefits hand book or contact the customer service section of your health plan to inquire about your responsibility to complete these requirements.

To make the admission and billing processes easier, please verify your health insurance coverage and hospitalization requirements, and complete any necessary pre-certification documents before your admission. Appropriate medical claims will be submitted to your insurance company following your dismissal. If your group insurance requires an Employer Claim form, please complete and submit it upon dismissal. As a courtesy to you, we will process your insurance claim.

Managed Care Health Insurance Plans
Managed Care health insurance pays for your health care needs, and also provides your health care within the Plan’s selected network of providers. Most Managed Care health plans require members to choose a Primary Care Physician (PCP), and obtain referrals from their PCP to see a Specialist.

What is a Primary Care Physician (PCP)?
A Primary Care Physician (PCP) is a doctor who will provide and coordinate all of your medical care. PCP’s have specialties in:

  • General Internal Medicine
  • Family Practice/General Practice
  • Pediatrics

What is a Referral?
A referral is permission from your physician to seek care. Things to remember about a referral:

  • Be certain the referral is for a service covered by your health plan.
  • The referral should be to a provider within your Health Plan’s network.
  • Check for limitations on the referral such as number of visits allowed or expiration date.

Reminder:
Contact your physicians about a referral prior to your appointment.

What is an Explanation of Benefits (EOB) or Explanation of Payment (EOP)?
An EOB or EOP are documents mailed by your insurance company directly to you and Faith Regional showing a detailed listing of how your insurance company processed your claim or bill.