Diablo Medical Billing is a third party medical billing company with over 20 years of knowledge and experience in medical billing services. Your doctor has contracted with our company to manage his/her patient billing and insurance submissions.
Your protected health information security is our primary goal throughout the billing process. You can be assured we meet or exceed the Health Insurance Portability and Accountability Act (HIPAA) and the OIG Compliance Program Guidance for Third-Party Medical Billing Companies. Please feel free to read our privacy statement.
You may have questions about a bill that you have received. Before contacting our office, we kindly ask that you review our Frequently Asked Questions.
Frequently Asked Questions
Why doesn’t my doctor’s office process the billing?
Because of the complexities of the health care industry physicians will sometimes utilize a third party medical billing company to manage all the insurance and patient billing. For the most part the information about the medical billing company is invisible to you; our name does not appear on any bills and in most cases payments do not come to our office. The only time you will become aware of our presence is when you have questions. At that time, you will contact our office to answer your questions or to resolve your billing matters.
How does Diablo Medical Billing get my information?
When you see a physician that utilizes Diablo Medical Billing’s services we receive all minimum necessary information from your doctor to bill your insurance or you (if you are self pay).
What does the insurance company do with the information you send to them?
The insurance company processes the bill and sends the physician an Explanation of Medical Benefits (EOB) for that service. This EOB will tell Diablo Medical Billing if there is any portion of the original service that you are responsible for paying. If that is the case we will then bill the patient or the legal guardian.
What is the date of service?
The date of service is the date you saw the doctor or had a lab procedure done.
What does “procedure” or “services” mean?
These refer to the treatment you received in the doctor’s office, hospital, or urgent care center, and may include an immunization, lab, x-ray, or exam.
I don’t recognize the doctor’s name that is printed on my bill. Why is that?
You may not always recognize the physician or physician group that is listed on your bill. This is because you were seen in an emergency room or inpatient hospital by a “hospitalist.” Today, many physicians use hospitalists to care for their patients when they visit emergency rooms or are admitted to the hospital. The hospitalist communicates with your primary physician, but handles your care during time spent in the hospital.
Why do I get a bill if you are billing my insurance company?
Your insurance has processed your claim and indicates you have a financial responsibility. Some of the reasons for getting a bill may include a deductible not yet met, any co-insurance you owe, or having an unpaid co-pay at the time of visit.
Why did the insurance company state I’m responsible for this amount?
You are responsible for co-insurance, co-payments, deductibles and non-covered services. Check your insurance website for details of your specific policy.
Why do I have a deductible?
Every policy is different. Check with your carrier for details of your specific policy.
Why was my visit not covered?
Many services are not benefits of health insurance. Some examples are: routine services, pre-existing conditions, and travel immunizations.
Why am I also getting bills for outside labs?
Our bill is for physician’s services. Example: If you had blood drawn, it is sent to the lab for testing. The lab will bill you separately.
Why are the charges so high?
Physician fees are standard for the practice locality.
Do you have the correct insurance?
If your insurance has processed a claim for these services, then we are billing correctly.
Can I make payment arrangements?
Yes, although, each practice has their own policies.
Can I get a discount?
Discounts are determined by the physician on a case-by-case basis. It’s best to send a written request to your physician.
What is a contractual adjustment?
Contractual adjustments are the difference between what the doctor bills and what your insurance allows if your doctor is contracted with your insurance carrier.
Where do I find the phone number of my insurance carrier?
You can find their phone number on the back of your card or on their website.
Which of my insurances is primary or secondary; how is that determined?
Primary and secondary insurance is determined by the insurance carriers based on employment status and date of birth.
Can I get a discount since I’m uninsured?
Discounts are determined by the physician on a case-by-case basis. It’s best to send a written request to your physician.
Why did my doctor use a pre-existing condition?
Claims are billed with the diagnosis or symptom for which you sought treatment. This is provided to us by the physician, based on chart documentation.
How do I find an in-network provider?
Check your insurance carrier’s website or call the number on your card.
Why was another statement sent when I already paid this balance?
Sometimes statements and payments cross in the mail, or the payment has not yet been posted.
Who do I contact if I have been sent to collections?
You may contact the collection agency directly. They become the owners of the debt. Their phone number is on the statement they sent you.
Where do I send my payments?
Payments should be sent to the address on your bill.
Why was my old insurance billed?
We bill with the information provided to the office at the time of service.
Did you bill my secondary insurance?
If you provided us with the insurance information, we billed your secondary insurance.
Can I pay with a credit card or HSA card?
Most of our physician practices take credit cards. If your physician does not, that will be stated on your statement.
Will you take payments over the phone?
If your physician takes credit cards, we can take the payment over the phone.
What does “insurance pending” on my bill mean? Did you bill my insurance?
Those claims have been sent to your carrier but we have not received an Explanation of Benefits (EOB). For example: Often insurance carriers will pend claims awaiting answers to a questionnaire they sent to a patient. They are usually looking for information about a pre-existing condition or other insurance information.
Helpful Terms to Know
Co-insurance
Co-insurance is the amount you are required to pay for medical care in a fee-for-service plan after you have met your deductible. The coinsurance rate is usually expressed as a percentage and depends on your plan. For example, if the insurance company pays 80% of the claim, you pay 20%.
Contractual Adjustment
Contractual adjustments are the difference between what the doctor bills and what your insurance allows if your doctor is contracted with your carrier.
Copay
A fixed fee that subscribers to a medical plan must pay for their use of specific medical services covered by the plan.
Deductible
The deductible refers to the amount of money that the insured would need to pay before any benefits from the health insurance policy can be used. This is usually a yearly amount so when the policy starts again, usually after a year, the deductible would be in effect again.
Explanation of Benefits
An Explanation of Benefits (EOB) is an itemized statement provided by your insurance company. It details what action your insurance company has taken on your claims. You should keep EOBs with your health insurance records for reference.
Primary and Secondary Insurance
Since many people have available medical insurance from more than one plan (such as two employed spouses covered under group health insurance plans), insurance companies do not want insureds to profit through their health insurance. To prevent double recovery, most health insurance plans have provisions which determine how primary versus secondary coverage will be determined. Primary coverage is provided through the plan of which they are a member (such as the spouses both covered through their respective employment - the primary coverage is provided under the plan provided by the employer of each spouse) or the plan under which the member has been a participant for the longest time period. Secondary coverage, usually as a result of being covered as a dependent under someone else's health insurance plan, provides reimbursement for medical expenses after exhaustion of coverage available through the primary plan.
Procedure Code
A current Procedural Terminology (CPT) code used by a physician or other provider to describe the procedure or service rendered to the patient.
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