Common Insurance Terminology and Definitions

Prior Authorization: An approval from a health plan that may be required before you receive services or fill a prescription in order for the service or prescription to be covered by your plan.

Date of Service: Specific time at which a patient received supplies, products, or services.

HCPC: The Healthcare Common Procedure Coding System produced by the Centers for Medicare and Medicaid Services (CMS) that represent supplies, products, and services. The codes are used to facilitate the processing of health insurance claims by insurers.

HCPC Description: Written representation of the HCPC code and the supplies, products, and services received by a patient.

Billed Amount: The amount billed to your insurance for this HCPC. Insurance only pays based on their Allowed Amount.

Allowed Amount: The maximum amount an insurance plan will pay for a covered health care service or supply.

Insurance Paid: The amount the insurer paid Aeroflow Health for services and supplies based on the allowed amount and the patient’s benefits during a coverage period.

Deductible: The amount you owe during a coverage period (typically one year) for covered health care services and supplies before your plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to deductible.

Coinsurance: Your share of the costs of a covered health care service or supply, calculated as a percent (for example, 20%) of the allowed amount for the service or supply. You pay the coinsurance plus any deductibles you owe.

Patient Responsibility: The total amount of Deductible and Coinsurance owed by a patient for health care services and supplies.

Explanation of Benefits (EOB): An insurance company’s written explanation regarding a claim, showing what the health plan paid and what the patient must pay based on benefits at the time of service. The EOB is not a bill, although it will explain any charges that the patient still owes.

Why did I get a bill?

The services or supplies provided were processed as a Medical or Durable Medical Equipment benefit and are subject to Deductible and/or Coinsurance. Please reference your Explanation of Benefits received from your health plan for more information on how your claim was processed.

How do I pay my bill or make a payment?

TBD

Why did I get an electronic billing statement and a paper statement in the mail?

Integrated Healthcare Solutions primarily communicates with our patients electronically and that includes billing-related communications. Once your insurance company has processed your claim, if you have a cost share we will email or text you with a link to view your digital statement and make a payment. If we haven’t received a payment after 2 statement cycles (~60 days), we will send you an email AND paper statement on the third statement cycle. If you prefer to receive paper statements ONLY, please contact the customer service team at the contact information on your statement to update your billing communication preferences.

Do you offer payment plans?

Yes, Integrated Healthcare Solutions offers interest payment plans and is committed to working with all of our patients to resolve outstanding balances and cost-share responsibility. Please contact the customer service team at the contact information listed on your statement to discuss payment options. 

Who can I contact if I have questions about my bill?

You may contact the customer service team at the contact information listed on your statement. Office hours are Monday through Friday, 8:00 am – 5:00 pm.

How do I get a copy of my itemized bill?

You may contact the customer service team at the contact information listed on your statement. Office hours are Monday through Friday, 8:00 am – 5:00 pm.

Do you offer financial assistance?

Integrated Healthcare Solutions is committed to working with all of our patients to resolve outstanding balances and cost-share responsibility. Please contact the customer service team at the contact information listed on your statement to discuss payment options and financial assistance. 

Why did I get a billing statement with multiple dates of service listed?

Integrated Healthcare Solutions patient statements are billed at the account level and will include all outstanding cost shares owed to Integrated Healthcare Solutions for all products and dates of services. Your account balance may include cost shares from multiple insurance claims adjudicated by your health plan. As Integrated Healthcare Solutions receives patient payments, the payment is applied to the oldest cost share balance on record. 

Why did I get a billing statement that didn’t have all of my supplies for a date of service?

As soon as insurance processes your claim for a supply that has a cost share, the supply will be included in your billing statement. It is possible that insurance will process supplies for the same date of service separately and they will qualify for a future billing statement.

I paid my estimated cost share balance when I placed my order, why am I getting a billing statement for my most recent date of service?

If you have a past due balance when you order supplies, Integrated Healthcare Solutions may collect the estimated cost share balance for the supplies up front. The payment is applied to the oldest cost share balance on record, so your billing statement may include your most recent date of service.