Frequently Asked Questions About Billing
If your billing question is not listed and answered below, please call Scripps patient financial services at 800-690-9070. For Scripps Clinic Business Services, call 858-784-5645.
Will you bill my insurance?
Scripps will first bill the medical insurance carrier on file. If, however, the claim is returned unpaid because the carrier indicated you were no longer eligible for coverage, we will bill you. If you have changed insurance companies, contact us as soon as possible so we can change the information on file and bill the account correctly. If we do not receive this information in a timely manner, we may lose our ability to bill the insurance company on your behalf. You would need to pay the bill, and then obtain reimbursement from your insurance carrier.
I gave my insurance information to my doctor. Why don’t you have it?
Physicians are independent contractors to the hospital. Each maintains his or her own patient information. Also, your benefit coverage may be different for a physician than for hospital services. For these reasons, physicians and the hospitals retain separate insurance information.
I was in the hospital three weeks ago. Why haven’t I received a bill?
Scripps will always bill the medical insurance on file first. Once the insurance has paid their portion, any remaining amount will be billed to you. Depending on how quickly the insurance carrier processes the claim, it may take three to 12 weeks for you to receive a bill.
I received a statement, but all it shows are totals. Can I have an itemized bill?
Itemized bills are available upon request. However, the portion you owe is seldom based on the total charges for the account, so the itemized bill may be of little use to you. Most insurance carriers negotiate a reduction from the total charges. The patient’s portion is then based on this contracted amount.
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 the hospital. 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.
My hospital statement had an adjustment amount. What was that for?
Insurance carriers negotiate discounts off of the hospital charges. The amount of the discount is specific to each carrier. When the carrier pays their portion, the contractual allowance is deducted to reflect the true amount due from the patient.
I’m covered under my insurance and my wife’s. The deductible is less under my wife’s insurance. Can you just bill her insurance and not mine?
Under a provision called coordination of benefits, the hospital is obligated to bill the insurance that would be considered primary for you. Any medical insurance for which you are the primary holder must be billed before any other medical insurance.
Even though I gave my medical insurance, I was later asked for my automobile insurance because my injury was due to an automobile accident. My medical insurance will cover the bill, so why is any other insurance needed?
When we bill your medical insurance for treatment related to an accident, the carrier will want to know if there is any other insurance that may be liable for the bill. For Medicare recipients, this is a requirement to bill Medicare. If we can not provide the information at the time of billing, the claim may be delayed, or even denied, until the information is given.
I went to the emergency room with a stomachache. The desk attendant refused to tell me how much my visit would cost until I saw the doctor. She wouldn’t even say if my insurance would cover the bill. Why couldn’t I find this out before seeing the doctor and incurring a bill?
When someone comes to the emergency room, it is implied that they have a medical emergency. Very specific regulations require that we first determine the extent of the medical emergency before we can discuss any financial questions. This means the triage nurse and the emergency room physician must first see the patient.
We understand that this restriction can be frustrating. However, the regulations are there to ensure that everyone who comes to an emergency room will be seen regardless of their ability to pay.
After my Emergency Room visit, I received four bills: one from the hospital, one from the emergency room physician, one from a radiologist group and another from a pathologist group. I only had one visit, so why four bills?
All of the physicians are independent of the hospital and bill for their services separately. They are required to bill on a different form than the hospital and sometimes even bill different offices at your insurance company. In your case, the radiologist would have interpreted any X-rays you had, and the pathologist would have examined any lab results or analyzed any specimens. Then, each of them would bill separately.
I happened to see a list of my charges once, but couldn’t understand a single one. Why can’t these be listed in layman’s terms so I can understand what I’m charged for?
With all the variety in medications, medical supplies, procedures and devices, it would be very difficult to list every item in layman’s terms and still know exactly what medication you were given or what procedure was performed. By listing the charges in medical terms, we can easily compare your bill to the medical record for accuracy.