Billing FAQs

We ask for your insurance information every time you visit our office to ensure that our records are accurate and up to date. Patients and/or employers change insurance carriers with great frequency. To process your bill quickly and accurately, we ask you for your insurance information on every visit. This gives us the opportunity to verify your insurance coverage and benefits.

Yes, the information on your insurance card is needed to file a claim with your insurance company or companies. When you register we will ask for information about your insurance coverage and have you sign some forms. You will also be asked to provide a valid form of identification. Copies will be made of your insurance card and your identification.

You should also be aware that you insurance card contains very important information about the co-pay amounts you are responsible for on different types of service. Please be sure to review this information prior to your trip to the clinic, if possible. If your insurance card does not provide a billing address, please obtain a correct address before you come to the clinic. This will avoid any delays in billing your claim.

Yes, we will bill your insurance company for you, provided you have given us complete insurance information, including the name of the company, the address to which claims are to be billed, your policy identification number, your group number (if applicable), and a phone number. It is your responsibility to provide any required information (referrals, authorization numbers, claim forms, accident information). It is also your responsibility to follow the rules of your insurance company.

We will bill your secondary insurance provided you have given us complete insurance information as noted above.

Many health insurance plans cover all or part of your visit charges, but policies vary widely on which procedures, services or items an insurance company will cover. Because policies are often customized, we do not always know what your policy covers. In order to maximize your health insurance benefits, it is very important that you familiarize yourself with the policies and benefits outlined in your health insurance handbook. Please read your health insurance handbook carefully. Should your health insurance handbook not specifically address these policies and benefits, please contact your health insurance customer service department for policy and benefit verification. The customer service phone number should be located on the back of your health insurance ID card

If our records indicate that you have a balance after your insurance pays, you will receive a statement indicating your account balance after we have completed processing the payment.

Our billing department will send you a detail bill if you owe a patient balance after your insurance provider has paid or denied its charges. If balances remain open for more than 30 days, you will receive a account summary each month until all outstanding balances are paid.

Please read this correspondence carefully, as it contains important information regarding the status of your account. If you are covered under an insurance policy or another party is responsible for your bill please notify us.

As part of our normal billing process, we make several attempts to contact you to let you know what portion of your bill you are personally responsible for. We determine the amount you are responsible for after we have received payment or denial of payment from your insurance company. You may receive notice from a collection agency if, after repeated attempts to contact you, we have not heard from you.

To make payment arrangements, call our office and we will work with you.

Your deductible and coinsurance amounts are determined by the insurance plan in which you are enrolled. This information should be included in your insurance benefits handbook. If you cannot find this information or have other questions, contact your insurance provider.

Your payment will be applied to the account with the oldest date of service unless you specify an account number and date of service to which payments should be applied. Indicate the account number and data of service you would like the payment to be applied to by writing them on your check.

Co-insurance is the portion of your health-care expense not covered by insurance. A co-insurance is usually a percentage, like 10 percent or 20 percent. For example, on a $500 bill, your deductible might be $150, so you would have to pay the first $150. This leaves a balance of $350. Of the $350, your co-insurance might be 20 percent, meaning you will have to pay an additional $70. Your insurance will pay the remaining $280.

A co-payment is a type of cost sharing whereby the insured person typically pays a specified flat amount per unit of service or unit of time (e.g., $10 per visit, $25 per inpatient hospital stay, or $75 per emergency room visit) with the insurance paying the balance.

A deductible is a set dollar amount such as $250 or $500, which you must pay before your insurance plan will begin reimbursement for your hospital charges. A deductible can be set for either an individual or an entire family.

Why do I still owe a balance if my insurance company has been paid? Based on your insurance plan, you may be responsible for deductibles, co-pays and co-insurance for fees not covered by your insurance company.

If I receive services because of an accident at work, will you send the claim to my employer? Due to confidentiality, we are unable to send bills directly to your employer. However, we will send claims directly to your employer’s Workers Comp carrier. We will need the name, address and claim number. You may take your bill to your employer and work directly with them.

In Person:

You may pay in person at our office.  

Through the Mail:

You may submit payment by mail by sending it to our office address 

          49 ATWOOD RD, PO BOX 434, PELHAM NH 03076

By Phone:

You may pay by phone by calling: 603-635-2802

By Online:

www.pelhamhealthcareassociates.com

Our providers are dedicated to taking care of a patient’s needs and our mission is to serve you as an individual and treat you. Because we are interested in serving your needs to the best of our abilities, we may order blood work or other labs according to your age, gender, medical conditions, or medications that you may be taking.  However, we do not have any control over your insurance coverage of these tests, nor do we have any control over how the laboratory, which you select or we send, chooses to bill you. Therefore, we unfortunately are not able to answer questions about billing with regard to laboratory services. We understand that it can be very frustrating to receive a bill for non-covered services, but unfortunately the providers at PHA unable to help with this situation. We suggest you call your insurance company or lab if problems arise. Additionally, we strongly suggest that you always check with your insurance prior to having lab work done in order to ensure coverage. As always, we do not restrict you to any particular laboratory and ask that you check with the lab you are visiting also to ensure insurance coverage. If there is a problem with a bill that you have received from PHA, please do not hesitate to call us.

Preventive care includes services such as checkups, screening tests, and immunizations:  care that you get when you’re symptom-free and have no reason to believe you might be sick.

Diagnostic care is what you get when you have symptoms of an illness or injury or are being followed for a chronic condition, and your doctor wants to diagnose or monitor the condition. This may include an office visit, tests, or treatment(s).

Diagnostic and preventive care may occur during the same visit.

For example, you may have a checkup during which your doctor discusses a chronic illness you have. Some of the tests ordered that day may be preventive (such as a screening mammogram) and others may be diagnostic (such as a blood sugar test for a diabetic).

Sometimes, when you see us for preventive services such as checkups, screening tests, and immunizations, you may also receive diagnostic services. Diagnostic care is what you get when you have symptoms of an illness or injury or are being followed for a chronic condition, and your doctor wants to diagnose or monitor the condition. This may include an office visit, tests, or treatment(s). For example, you may have a checkup during which your doctor discusses a chronic illness you have. Some of the tests ordered that day may be preventive (such as a screening, like a colonoscopy or mammogram) and others may be diagnostic (such as a blood sugar test for a diabetic).

In most cases, you don’t pay anything for preventive care (unless your plan has “grandfathered status.” ) But you may have to pay something for diagnostic care. And if both preventive and diagnostic care occurred at the same visit, you may have to pay something (copayment, deductible, or co-insurance) for the diagnostic services.

If you have specific questions about your plan and what is covered, you can call the Member Service number on your ID card.