Glossary of Terms
Covered: The service rendered is subject to the payment terms of your plan, co-insurance, co-payments, and deductibles may be applied. Covered does not mean the plan will pay 100% of the cost of the rendered services.
Plan paid: The amount your plan will pay to the provider directly for the services rendered, co-insurance, co-payments, and deductibles may be applied.
Cost Sharing: The “out-of-pocket” amount you would have to pay for the services rendered. Cost sharing includes co-insurance, co-payments, and deductibles. All plans are different you should check with your plan to find out your personal financial responsibility.
Deductible: The amount you are responsible for paying before your plan will pay. All plans are different you should check with your plan to find out your personal financial responsibility.
Co-Payment: The amount due at the time of the visit. All plans are different you should check with your plan to find out your personal financial responsibility.
Co-Insurance: The amount you are responsible for paying after the claim is processed. It is usually a percentage of the services rendered. All plans are different you should check with your plan to find out your personal financial responsibility.
Personal Financial Responsibility: The amount you are responsible for paying after services are rendered. This amount is subject to the payment terms of your plan. Sometimes the plan pays in full, and other times the plan has cost sharing. All plans are different you should check with your plan to find out your personal financial responsibility.
Will PINK Bill my insurance carrier?
Yes. If your insurance information is in our billing system when the services are entered, your insurance carrier will be billed directly. However, if the information is inaccurate or incomplete, we may be unable to bill your insurance carrier. Providing us with your current billing information at the time of your visit is critical to expediting the billing process. Promptly notifying us of errors when you receive a bill allows us to make necessary updates and re-submit the claim to your insurance carrier in a timely fashion.
Did my Insurance Carrier pay for the services?
Any payments from your insurance carrier will be reflected on your statement. In addition, many insurance carriers send the Explanation of Benefits (EOB) to their subscribers explaining how their medical claim was processed.
Why didn’t my Insurance Carrier pay for the services?
To obtain a clear understanding of your benefits and any limitations of your insurance coverage, it is best to contact your insurance carrier directly for an explanation of the way your claim was processed and/or denied. When your claim has been denied, you have the right to appeal all decisions. Check your insurance carrier website for their policies and procedures.
Why am I getting a bill now, when the services were provided so long ago?
Once a response is received from your insurance carrier and we have confirmed the patient has a personal financial responsibility, there is additional patient liability, we will bill the patient. However, this process is dependent on when we receive a response from the insurance carrier. In addition, insurance carriers often request additional information that could delay the processing of your claim. Often on your behalf we will appeal a denial and explain all charges to help with the payment.
Why am I getting a bill?
You are getting a bill because your account has a remaining balance due. This balance due is your responsibility. PINK Breast Center believes in providing cutting edge technology at a reasonable rate and depends on full payment in order to provide the services.
Will my insurance pay for my Annual Screening digital mammogram?
Most Insurance companies will pay 100% of the cost of your annual screening digital mammogram. There are some exceptions. Some employers self insure, and they are allowed to apply cost sharing to your annual screening digital mammogram. However, this is rare. If you would like to be certain you should contact your carrier directly and ask specifically about your plan coverage.
Your Radiologist may ask for additional Imaging, theses services will be subject to the coverage terms of your plan. Co-payments, Co-insurance, and deductibles may apply.
Will the Insurance pay for my 3D Digital Mammogram?
3D Digital Mammography-Tomosynthesis is a new procedure and some of the insurance carriers do not have a code for submission yet or are refusing to pay for the service. As such, there is a patient fee of $65.00 for the 3D portion of the study. Our fee for the 3D Digital Mammogram service is based on the Medicare Rate. All services rendered are billed to your insurance. The screening 2D exam charge at this time is paid in full by most insurances. The 3D digital mammogram exam fee may or may not be covered. Sometimes, it is a covered exam but is applied to your deductible. If you have not met your deductible for the year then you will be responsible for the service. Often the responsible payment amount for the 3D digital mammogram is less than the Medicare rate and is based on an insurance carrier’s individual contracted rate. Should you have any questions, our billing staff is available to help you at 973-341-1127 ext. 3.
Will My insurance plan cover Additional Imaging?
Your radiologist may ask for additional imaging, including a diagnostic digital mammogram or a breast ultrasound. Your insurance plan will always cover these services, but you may have a personal financial responsibility as a result of cost sharing. Additionally, New Jersey has a breast cancer screening law to require insurers to cover additional imaging in the event you are found to have dense breast tissue. Visit our resources tab to read a copy of the law.
Will the Insurance pay for my Ultrasound exam?
It is always a covered service when it is necessary (breast pain, dense breasts, lump, mass, discharge, abnormal digital mammogram etc.), but it depends on how it is paid. This varies based on your individual insurance carrier. Sometimes they simply pay the charge and sometimes it is applied to your deductible and you are responsible for payment. To obtain a clear understanding of your benefits and any limitations of your insurance coverage, it is best to contact your insurance carrier directly for an explanation of what is covered and what is not.
Should I contact my insurance carrier before coming to PINK Breast Center?
It depends on the services you are going to receive and your particular insurance policy and benefits. Screening Digital Mammograms are considered preventive care and are covered 100% by all Insurance carriers. In general, it is a good idea to review your insurance policy and benefits before receiving any medical services.
I am also covered on my spouse’s insurance policy. Will PINK Breast Center send bills to both insurance companies?
The billing department at PINK Breast Center will coordinate benefits for patients covered by more than one insurance policy, if we are given the complete information at the time of service. Primarily, we will send the bill to your insurance carrier.
I cannot pay my whole bill at once. Can I make payment arrangements?
We are always willing to work with our patients. We understand the high cost of healthcare in New Jersey, We live here too! We can arrange for payments on a schedule to billed to a credit or debit card. Please call 973-341-1113, and a representative will assist you.
How much is my Deductible and Coinsurance?
Your deductible and coinsurance amounts are determined by the insurance plan in which you are enrolled. This information should be included in your insurance benefits handbook. If you cannot find this information or have other questions, contact your insurance carrier.
If I do not have an insurance plan, how do I know how much to pay? Whom do I pay?
In general, PINK Breast Center uses the usual and customary rates based on Medicare. For more information of payments and prices, please contact our Paterson office at 973-977-6662 or our Flemington office at 908-284-2300.
Do I need to bring anything with me when I come to PINK Breast Center?
Please bring your insurance card and photo ID which is needed for the registration and billing process. If required, you should bring in any referral or authorization form that your primary care physician has given you, indicating the need for the services you will receive. No prescription or referral is needed for a screening digital mammogram.
Why does the statement show a total account balance when I have Insurance coverage?
It is probably because PINK Breast Center hasn’t yet been paid by your insurance carrier or it has been denied. If your insurance plan does not cover the services you received, you are financially responsible. Our billing office is available to help you with questions and if needed a payment plan.
How do I know that the amount you are billing me is the correct amount?
Once your insurance carrier pays their portion of the bill, they will send you an Explanation of Benefits (EOB) to show how the claim was paid. You can compare your EOB to the statement sent by PINK Breast Center. How the carrier paid the claim is based on their contract with us and their contract with you. If you feel the insurance company should have paid a higher amount, please contact them directly for resolution.