Key Terms

Healthcare is not a universal language; here are some of the key terms you may encounter during the billing process:

• Allowable charge Also known as the "allowed amount" or maximum allowable; this is the dollar amount considered by a health insurance company to be a reasonable reimbursement rate.

• Co-Insurance Percentage of coverage that a patient is responsible for paying after an insurance company pays the portion agreed upon in the health plan. Co-Insurance percentages vary depending on the health plan, and may be subject to your deductible. Co-Insurance and Co-Pays are two separate distinctions. Co-Pays are set, out-of-pocket expenses not typically subject to deductibles. You are likely to have a Co-Pay when picking up prescription drugs, or during an appointment with your physician or other healthcare provider.

• Deductible The amount the insured (customer) has to pay out of pocket for expenses before the insurance plan begins to pay. Deductibles range in price according to the terms set in your specific policy.

• Explanation of Benefits Also known as the EOB- A document attached to a processed medical claim wherein the insurance company explains the services they will cover for a patient's healthcare treatments. EOBs may also explain what is wrong with a claim if denied.

• Claim A statement from a health care provider or patient presented to an insurance company for payment for services performed.

• Healthcare Financing Administration Common Procedure Coding System (HCPCS)HCPCS is a coding system used to explain services, devices, and diagnoses administered in the healthcare system. Medical billing specialists utilize codes in the HCPCS on a daily basis to file claims. If you are calling your insurance company to find out if a particular item is covered, they will ask you for the HCPCS associated with that supply or equipment. Call us - we can help!

Our billing process begins when you receive a new piece of equipment. The Norco team will go over the various forms your insurance company requires to process the claim. Medicare and other insurance companies may need additional documentation, which we will work towards obtaining but may need your assistance. Insurances base reimbursement on medical necessity documented by your doctor along with additional coverage criteria. A doctor’s prescription does not guarantee coverage. At that time, Norco will decide whether to accept assignment.

When is my payment due?

You will be required to pay for any services or equipment that are not covered by your insurance. We will request this payment at the time of service. For your convenience, we accept personal check, cash, debit, and credit cards. These payments may include a deductible or co-insurance amount. You may receive an additional bill in the mail after your insurance has paid your claim. This could be for various reasons- commonly it is because you have not yet met your deductible, or your claim was denied. Failure to pay for services for which you are responsible for may result in your account being referred to a collection agency.

We appreciate you choosing Norco for your medical needs. We are committed to serving you better and it is our goal to avoid any misunderstandings regarding our financial policy.