Westcare Clinic frequently receives questions related to insurance and billing. We have answered many common questions below.
Please contact our billing department at (360) 357-9392.
INSURANCE AND BILLING FAQS
Contact your insurance company to make sure you understand your benefits and your plan’s requirements. Confirm that Lynx Healthcare is a contracted provider of services for your plan.
Obtain a referral, if required by your insurance company. Please note: Westcare Clinic does not require referrals, but your insurance company may require them to provide coverage of your visit or procedure.
Discuss your referral with your primary care physician prior to scheduling an appointment with one of our specialists. Know the limitations of the referral and obtain an extension or expansion of the scope of the referral if needed.
Coverage varies with each insurance company. Please refer to your insurance member handbook or call your insurance company with questions regarding benefits and covered services.
Staff may not know whether a service will be covered. Your insurance plan may not always cover medically necessary and appropriate services
We recommend that you contact your insurance plan or provider directly if you have questions about whether something requires precertification or authorization.
Each service a patient receives during an office visit has an American Medical Association code associated with it. The billing statement for your visit includes these codes. They inform your insurer of the services provided and why they were provided.
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CPT codes (current procedural terminology) identify the services performed and the reason they were performed.
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ICD-9 codes (international classification of diseases) specify the diagnosis associated with your visit.
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Yes. To make sure we have the right billing information, we will ask to see your insurance card at every visit. We also will ask you to verify your name, address, Social Security number, and employer.
If your claim is for a work-related injury or motor vehicle accident, you will need to provide the necessary information to bill the liability insurer. To comply with government guidelines, we will ask you to sign a form verifying this information.
If insurance information is not available or not provided to us, the account will be billed directly to you.
Please remember that you are ultimately responsible for the charges on your account for treatment you received. Westcare Clinic will not become involved in liability disputes.
Federal law requires appropriate, accurate coding. Coding must reflect what happens during your medical visit and match what is recorded in your medical record.
When denied coverage, people sometimes are told that they would have been reimbursed for a specific procedure if another code had been used. It is against the law to change codes just to obtain reimbursement.
It is important to understand your coverage so that you will not be surprised if a service is not covered.
If your insurance information was provided when you registered, you will not receive a bill until your insurance company has:
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Denied the claim
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Paid the claim and there is a co-insurance, deductible, or noncovered service for which you are responsible
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Not responded to the claim
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Determined your coverage is not valid or cannot be verified for the date the services were provided
Payment of your bill is ultimately your responsibility and due upon receipt of your first statement.
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You may still owe copays, deductibles, and coinsurance for fees not covered by your plan.
Please contact Westcare Clinic to provide any new information so we can make sure your claims are processed correctly. You can also bring your new card or information to your next visit.
An EOB is the notice you receive from your insurance company after receiving medical services from a doctor or hospital. It tells you what was billed, the payment amount approved by your insurance, the amount paid, and what you have to pay.
Copays are set amounts you pay when you go to a health care provider. Providers usually collect copays at the time of the visit. Copay amounts are listed on your health insurance card.
Deductibles are the yearly expenses you pay before your health insurance pays anything. For example, each year you may have to pay the first $1,000 of your health care bills before your health insurance pays anything.
Your out-of-pocket cost is based on the total amount that your insurance has allowed for the visit, NOT on the clinic charges.
Coinsurance is a percentage of the health care bill that you pay. For example, you pay 20 percent and your insurance company pays 80 percent. Your out-of-pocket cost is based on the total amount that your insurance has allowed for the visit, NOT on the clinic charges.
The usual and customary fee schedule is set up so that noncontracted providers are reimbursed at a rate comparable to other HMO reimbursements in the same geographical area. The patient is responsible for charges that exceed the usual and customary rate.
If you would like to pay your balance in full, please use one of the following options:
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Log in to the patient portal of our website using your account number and the PIN found on your statement.
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Use the telephone number listed on your bill to call a patient account representative. You may pay using a debit card, credit card, or an electronic check transaction. We accept most major credit cards and bank debit cards.
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Mail your payment with the billing statement you have received.
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Make a payment in person at the facility where you received care.
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