Welcome. I’m Dr Cindy Oberholtzer-Classen
(my patients call me Dr. O). I’m the founder and owner of Podiatry Associates.
The past couple years have seen quite a few changes in the healthcare arena regarding
billing and collections along with high deductible insurance plans.
I would like to take a moment and address many of the frequent questions and areas of
confusion that we hear about in our billing department.
What is the difference between a charged amount and an allowable amount?
Charged Amount – This is the “list price” typically charged for a medical service but
not the final price that you will be ask to pay for that medical service. At Podiatry
Associates, we use an independent consultant to review and set those charged prices based
on national averages. Those charged prices are then submitted to Medicare, Medicaid,
and all commercial insurances that we do business with.
Allowable Amount – Medicare, Medicaid, and all commercial insurances have an allowable
amount which is a set contracted amount with individual medical practices and medical providers.
This is a portion of the “charged amount” that the insurance companies will pay for
each medical service. Allowable charges are different for each insurance carrier and can
vary between individual insurance companies insured through the same insurance plan.
Co-Pay – This is the amount that Medicare, Medicaid, and commercial insurances require
the patient to pay on their office visit as part of their individual plans. We as a medical
practice are required to collect that copay before your office visit starts.
High Deductible Plans – We have seen deductibles increase significantly the past five years
and some families now have deductibles as high as $5,000 to $10,000 per year. It is
important to know that you as the patient are to pay 100% of your family or individual
deductible before your insurance will make a payment on your behalf.
Another important topic is the responsibility to verify covered services and medical providers
approved by your insurance plan. Ultimately it is the patient’s responsibility
to confirm and know which doctors and services are covered by your health plans. These plans
are not the same nationwide and coverage can even vary by patient’s individual employer’s.
We will do our best to help in the benefit and precertification process but as the patient
you are ultimately responsible. To help us provide and obtain more accurate information
about your plan, please bring your insurance card and a valid government-issued ID to your
appointment. I hope this clears up some of the common questions
we get in billing. If you have any further questions, please call our main number at
303-805-5156 and ask for a representative in our billing department.