Before insurance companies can be billed for the services provided to you, you must register your insurance company and policy number with our business office. You must also authorize the clinic to file your insurance claim. The Business Office is available to assist you in requesting that the insurance company pay for the services that the clinic has provided to you. We will help you file and try to get the insurance company to pay as much of your balance as we can. Ultimately, you have paid the insurance premium directly or had it deducted from your payroll account so that you are the insurance company's customer, not The Jackson Clinic. Any amount that the insurance company does not pay will be your responsibility.
The Jackson Clinic is able to file your claim electronically for quick evaluation if your insurance company is programmed to receive an electronic filing. If your insurance cannot receive the claim electronically, we will mail them a paper copy. There are times that the insurance company does not acknowledge receiving claims that were mailed via paper or electronically; therefore, six percent of claims must be filed more than once to get the insurance company to even respond to the filing. We may have to request that you participate in the communication with your insurance company or even the state insurance commissioner. These efforts are to reduce the amount that you will have to pay for your medical treatment.
Your first billing from The Jackson Clinic will arrive after the clinic has had time to file your claim and to receive a response from your insurance company. The statement will show the clinic's charges and the response from your insurance company. If we do not receive a response from your insurance company, the statement will be mailed so that you and the clinic may begin working to get your insurance company to acknowledge and respond to our filing. Your insurance company will also send you an Explanation of Benefits (EOB) that explains the coverage your insurance company has allowed for your clinic visit. Your insurance company may have paid your claim, paid a portion of your claim, disallowed the claim, or not responded. You will be billed for deductibles, non-covered charges, co-insurance, and amounts that your insurance company has failed to address after a reasonable time.
Please keep in mind that services provided by a Jackson Clinic physician at a hospital or outpatient center are billed separately from the facility. You will also receive a bill from the hospital or outpatient center that will include the use of their facility or services. The Jackson Clinic does not receive an Explanation of Benefits (EOB) that explains the coverage your policy provides for the clinic visit. Any questions about what was paid or not paid should be directed to your insurance company. If you need help understanding the EOB, or if the payment applied to your account does not match the EOB, please bring the EOB to a patient representative for assistance. If you wish to discuss the EOB by telephone, it would be helpful if you would mail, fax, or e-mail the EOB and ask to be called to discuss your question.