Because every patient’s insurance plan is unique to him or her, answers to your specific questions may need to be directed to your human resources representative or your insurance carrier. There are, however, some basic questions and answers that relate to every patient:
What is a claim?
A claim is a request for reimbursement that’s submitted by your healthcare provider to your insurance provider in anticipation of receiving payment for services rendered.
What is an Explanation of Benefits (EOB)?
An explanation of benefit (EOB) is a documentation of a claim and the allocation of financial responsibility for that claim sent to you by your insurance company. An EOB is specific to a provider and the service(s) rendered by that provider. An EOB should always identify the provider, service date, actual billed amount, network discount, allowed amount, insurance portion, patient responsibility, and deductible amount.
What is the difference between the Billed
and the Allowed amount?
The Billed Amount is the amount your provider charged for a service. The Allowed Amount is the amount that they have agreed to accept based on a contractual agreement with you or your insurer.
How do you know if a claim is denied?
The EOB (Explanation of Benefit) sent by your insurance company details the provider payment and how much you may still owe. It may also indicate that your claim has been denied. Be sure to review the paperwork to understand why the claim has been denied. Typically, there will be a “Reason Code(s)” and explanation listed on the EOB.
Who do I call with questions about my bill?
The Patient Accounts department at Primary Care Associates of Appleton can assist with any billing questions you may have. You may reach us by calling (920) 996-1055. Our customer service representatives are available Monday through Thursday 8 a.m. to 5 p.m. and Fridays 8 a.m. to 4:30 p.m.
I misplaced my billing statement.
Where do I send payments?
Please mail your payments to:
Primary Care Associates of Appleton, Ltd.
Attn: Patient Accounts
3916 N Intertech Court
Appleton, WI 54913
If you know your account number, please write it on your check. We can also accept credit card/debit card payments via the telephone – please call (920) 996-1055 to speak to a customer service representative. We currently accept Visa, Mastercard, Discover and American Express.
What if I am unable to pay
my entire balance today?
Primary Care Associates of Appleton offers payment arrangements when you are unable to pay your entire bill. Contact our Patient Accounts department at (920) 996-1055 to discuss and arrange a mutually agreeable payment schedule.