We recommend you wait until you receive a bill from your medical provider before making payment. The amount could change depending on your individual insurance coverage.
We recommend you keep the Explanation of Benefits (EOB) forms you receive from Medicare until all your medical claims have been paid in full. If you have other health insurance in addition to Medicare, your insurance company will normally require a copy of the EOB before they will pay any remaining balance on your account.
Click Here for a detailed answer on the Medicare website www.medicare.gov
Part A covers inpatient hospitalization and Part B covers outpatient and physician services.
The Explanation of Benefits (EOB) form is an information document that Medicare sends to you after it has processed your medical claims. The EOB provides you with information about the payment status of your bill.
The guarantor is the person legally responsible for all charges incurred by the patient. If the patient is over the age of 18, then they are listed as their own guarantor. Exceptions would include:
- Full-time high school/college students covered under their parents insurance. If parents are divorced or separated, the custodial parent is the guarantor. If the custody is equally shared, the parent who has the insurance coverage on the patient is the guarantor.
- If a patient is mentally or physically challenged, and resides with a parent or legal guardian, the parent or legal guardian is the guarantor. If the patient lives in a group home, the patient is his/her own guarantor.
If the patient is under the age of 18, the guarantor is determined as follows:
- If both parents are married to each other and live at the same residence, the primary policyholder is listed as the guarantor. If there is no insurance coverage, the father would be the guarantor.
- If parents are divorced or separated, the custodial parent is the guarantor. If custody is equally shared, the parent who has the insurance coverage on the child is the guarantor.
The following applies to emancipated minors, then the patient/minor is their own guarantor:
- An individual who fathered a child.
- An individual whose mother gave birth to a child.
- An individual who has a court ordered document indicating that the patient/minor is emancipated.
A copayment is a required payment by the insured to pay a set or fixed dollar amount (i.e. $35, $50, etc.) each time a particular medical service is provided. Coinsurance is the portion of medical costs that are shared by both the insured (the patient) and the insurer.
Coinsurance is a form of cost sharing. After your deductible has been met, your insurance plan will begin paying a percentage of your medical bills. The remaining amount, known as coinsurance, is the portion due from the patient.
The deductible is a provision in many insurance policies that requires the insured to incur a specific amount of medical costs before insurance benefits are provided. For example, if a member’s policy contains a $500 deductible, the member must accumulate and pay $500 out-of-pocket before the insurance carrier will begin to pay benefits. Once the patient has met the deductible, the carrier usually pays a percentage of the bill.
A copayment is a predetermined fee the member pays to providers. Copayments are applied to emergency room visits, hospital admissions, outpatient visits, office visits, etc. The copayments are determined by your insurance plan and the cost is usually minimal. Patients should be aware of the copayment required prior to receiving healthcare services.
For information about the Health Insurance Portability and Accountability Act (HIPAA), please see http://www.hhs.gov/ocr/privacy/
If you disagree with the insurance company’s payment amount, contact the insurance company immediately and ask them to review how the claim was processed. If the insurance company finds that and error was made, note the information and with whom you spoke with at the insurance company. Request an anticipated payment date and ask if they need anything from you. If the insurance company feels the bill was paid correctly and you still disagree, find out from the insurance company what you need to do to file an “appeal” with them. Filing an appeal will not guarantee that the insurance company will pay more on your bill, but the claim will be reviewed for reconsideration. ProBill also offers various ways of helping you pay your bill such as payment plans or discounts for paying in full.
Your hospital has chosen to partner with an independent emergency room provider group to provide administrative and staffing services. Because the emergency room physician group is not employed by the hospital, the list of participating insurance plans may be different.
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 ProBill. How the carrier paid the claims is based on their contract with the physician group, if applicable, and their contract with you. If you feel the insurance company should have paid a higher amount, please contact them directly for resolution.
If an insurance carrier denies your claim due to a COB (Coordination of Benefits) please contact your insurance carrier immediately. If your insurance carrier sent information to your home requesting additional information necessary for them to process and pay your claim please contact them in order to avoid total financial responsibility for your unpaid claim.
Some insurance plans require that the patient or policy-holder receive payment, and then the policy-holder will pay the physician. If you have received an insurance payment for your emergency room physician services, please forward the payment along with your Explanation of Benefits (EOB) to ProBill or contact our Patient Services Department at 800-998-7578 (Monday – Thursday 7:30am – 5pm EST and Friday 7:30am – 4pm EST).
We cannot re-bill if the insurance has previously denied the claim. The insurance company will process the claim as a duplicate. If you feel that your insurance denied the charges in error, please call your insurance company. As a consumer, you always have the right to appeal a decision from your insurance company. Contact your insurance company to learn about their appeal process.
You are not being charged twice. Although services were rendered at the hospital, you may receive more than one bill for the same hospital visit. However these bills are for services by different and separate parties. One bill is from the hospital, and it covers charges for use of facility, equipment, medication and supplies. The second bill is from the physician or the physician group, and it covers the professional charges for the emergency physician’s services; this invoice is generated out of our Huntington, WV office.
ProBill recognizes that the cost of health care can be a significant, unexpected expense for patients. We can offer a payment plan that will allow you to make monthly payments and keep your account current. You may also qualify for a discount. Please contact Patient Services at 800-998-7578 (Monday – Thursday 7:30am – 5pm EST and Friday 7:30am – 4pm EST) for more information.
If you mailed your check, money order or credit card information it may take up to 21 days for your account to reflect the payment.
In the instance of a visit to the Emergency Room, you will always receive at least two bills: one for the services from the physician (professional fee) and one for the facility. Your co-pay covered the facility fee and this bill reflects the professional fee.
Most insurance plans require you to pay a deductible and/or coinsurance. In addition, you could be responsible for services not covered by your policy. Please contact your insurance company for specific answers to your questions. You should receive an Explanation of Benefits (EOB) from your insurance company indicating how much the insurance company paid and how much you owe in out-of-pocket expenses.
We apologize for this discrepancy. Please have your insurance card available and contact us at 800-998-7578 (Monday – Thursday 7:30am – 5pm EST and Friday 7:30am – 4pm EST). We will make the necessary changes to your account and bill the correct insurance.
In certain situations, we must consider the possibility that another party may be responsible for your expenses before we bill Medicare. For example, if you were injured in a car accident, at your work site or on someone else’s property, it is our responsibility to make sure those claims are filed appropriately. Consequently, we need to have complete information about all insurance coverage you have.
If you have given us information about your additional health insurance, we will bill that insurance company after Medicare makes their payment.
You can take advantage of our online payment option for many of the physician groups.
You can also make a payment over the telephone. Please contact our Patient Services Department at 800-998-7578 (Monday – Thursday 7:30am – 5pm EST and Friday 7:30am – 4pm EST) and we will work with you to facilitate timely payment.
If you choose to mail your payment, ProBill accepts check, money order, Visa, MasterCard, Discover and ECheck. Please pay the balance due by detaching the top portion of your bill and include it with your check, money order, or credit card information (include the credit card expiration date) in the envelope provided. Please include your account number on your check and use the appropriate mailing address as indicated on the bill.
If you do not know your physician group or need assistance with making a payment, please contact our Patient Services Department at 800-998-7578 (Monday – Thursday 7:30am – 5pm EST and Friday 7:30am – 4pm EST).
You can take advantage of our online payment option for many of the physician groups.
If ProBill has received your health insurance information from the hospital, we will bill the insurance company first. If for some reason ProBill did not receive the insurance information, it is important for you to call and make sure our records are up-to-date. Therefore, simply reviewing your health insurance information with a Patient Services Representative, or emailing this information to ProBill, enables us to bill or re-bill your insurance on your behalf and remove your invoice from a past-due account status.
If you have provided your insurance information, we will file your claim with your carrier. If you provide us information on a secondary carrier upon receipt of payment from your first carrier, we will bill them as well. You should receive an Explanation of Benefits (EOB) from your insurance company explaining what they paid. We find that insurance companies usually mail the EOB to you one or two weeks prior to sending us the check, therefore the payment may not appear on your next bill. We will send you a timely bill to keep you informed of your account status. If payment is not received in a timely fashion from your insurance carrier, we will request your assistance in contacting your insurance carrier for payment.
If you’ve been injured in the workplace, you can provide ProBill with your employer’s workers’ compensation insurance information and we will bill workers compensation on your behalf. Please contact Patient Services, as soon as possible, at 800-998-7578 (Monday – Thursday 7:30am – 5pm EST and Friday 7:30am – 4pm EST).
The ED is staffed 24 hours per day, and fees are based on the costs associated with being prepared for emergency trauma at any time of day or night. Non-emergency visits are far less costly when patients visit a physician’s office or clinic.
Due to the Health Insurance Portability and Accountability Act (HIPAA) regulations, ProBill cannot discuss information on the account unless we have prior consent from the patient.
The patient (or parent / legal guardian of a minor) needs to call the insurance company. The billing of insurance is a courtesy to you. Your insurance policy is a contract between you and your insurance company. Communication with your insurance company is your responsibility. ProBill does not have access to your policy nor the terms of its coverage. ProBill depends on you to provide the necessary information that is applicable to your specific policy.
Some insurance plans take up to 90 days or longer to pay a claim. If the physician group participates with your insurance, during this time we do not send out information to patients regarding their billing activity, as we have found this can cause overpayments. Upon receipt of payment from your insurance carrier, you will receive a bill from ProBill for any remaining balance, which includes details of your insurance payment activity and other useful information.
Although services were rendered at the hospital, you may receive more than one bill for the same hospital visit. However these bills are for services by different and separate parties – you are not being charged twice. One bill is from the hospital, and it covers charges for use of facility, equipment, medication and supplies. The second bill is from the physician or the physician group, and it covers the professional charges for the emergency physician’s services; this invoice is generated out of our Huntington, WV office.
No. ProBill is a medical billing company who bills on behalf of the provider or provider group. The collection agency used by the provider group is a separate entity.
The statement represents the professional charges for the emergency physician’s services you received at the hospital.
ProBill is a professional medical billing service located in Huntington, West Virginia. Founded in 1978 by a local physician, ProBill remains physician-owned today. With clients across the United States and over 100 years combined billing experience, we are able to deliver cost-effective, professional medical billing services for today’s complex market.