Frequently Asked Questions
What is a Community Health Center?
A Community Health Center is a nonprofit healthcare facility that offers a wide-range of primary and preventive health services to families and individuals of all ages. Our dedicated providers, nurses and support staff provide a continuous source of high quality and affordable medical care to the residents of Scott County and its surrounding areas.
What is a Federally Qualified Health Center?
Federally qualified health centers (FQHCs) include all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. FQHCs must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors.
What is Integrated Care?
Integrated healthcare systems is a practicing team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address mental health and substance abuse conditions, life stressors and crises, stress-related physical symptoms, and ineffective patterns of healthcare utilization. By combining the best traditions of primary care (adult, family practice, and pediatric services) and mental health services the integrated healthcare team is able to treat the whole person – mind and body, so that all patient needs are met. After meeting with an MPHC provider or nurse, a psychologist may assess and treat patients with behavioral concerns and work with the medical provider regarding referral questions and follow-up.
What to bring to your appointment?
- Insurance information
- Insurance co-payment
- All current medications in their original container OR a list of all medications with dosages. This includes prescription, over-the-counter and alternative or complementary medicines, herbs and supplements.
What is a specialty referral?
We provide primary care to our patients. Some patients have more complicated problems that may require the attention of specialized doctors. For example, we are able to refer patients to orthopedics, neurology, gynecology, podiatry, dermatology, urology, gastroenterology, hematology, and ophthalmology, among other specialty care providers, if needed.
If you get a referral, we will take care of scheduling your appointment, and give you all the instructions you need to see your new doctor.
How to read a MPHC billing statement
Insurance – Understanding the terms
Below are some terms that you may see or hear related to the billing of your services to your insurance company or if you call our billing office with questions.
Deductibles, co-insurance and co-pays are all amounts you may have to pay for healthcare services. Here’s how they work together.
What is a deductible?
A deductible is the amount you pay for healthcare services before your health insurance begins to pay.
For example, if your deductible is $1,500, you would pay 100 percent of your healthcare charges until the amount you paid reaches $1,500. After that, some services you receive may be covered at 100 percent, or you may have to pay co-insurance.
These are some other words you may see:
After deductible: This lets you know that the insurance company is now sharing costs with you for a service after you’ve met your deductible.
No deductible: You don’t have to pay toward your deductible for this service. You’ll still have to pay any co-pays.
Before deductible: The insurance will cover this service before you’ve met your deductible. You’ll still have to pay any co-pays.
What is co-insurance?
Co-insurance is your share of the costs of a healthcare service. It’s usually figured as a percentage of the total charge for the service. You start paying co-insurance after you’ve paid your plan’s deductible. Say you’ve already paid out (or met) your $1,500 deductible and your co-insurance is 20 percent. For a $100 healthcare bill, you would pay $20 and your insurance company would pay $80.
What is a co-payment?
A co-pay is a fixed amount you pay for a healthcare service, usually collected by the provider (doctor, nurse practitioner, physician assistant) on the date of your visit.
For example, a doctor’s office visit might have a co-pay of $30, which is the flat fee you pay for the visit.
Most insurance plans have co-pays, co-insurance, and deductibles. The amounts vary from plan to plan and we are required to collect the amounts outlined by your plan.
What is an EOB – Explanation of Benefits?
Another term you may see used is EOB or Explanation of Benefits. An EOB is sent to you by your insurance company to detail or explain the charges they paid or did not pay and why and what portion, if any, you may owe out of your pocket for the services.
What are In-Network/Out of Network Benefits?
In-network benefits are benefits available to you when you visit a doctor, hospital or provider that’s in your network (the group of providers your health insurance company has contracts with). In-network contracts allow the insurance company to cover your healthcare services at discounted rates. If you go to a non-contracted provider (out of network) the benefits paid by the insurance company will be less and your out-of-pocket costs will be higher.
What is Out of pocket maximum or limit?
Out-of-pocket maximum or limit is the maximum dollar amount you pay in deductible, co-payments and co-insurance during the year. Once you hit your out-of-pocket limit, your insurance company usually covers 100 percent of the allowed amount (the dollar amount your healthcare company has agreed to pay doctors and hospitals for healthcare services covered by your plan) for covered services. These amounts vary from company to company.
What is Pre-Authorization?
Also known as: pre-authorized service, prior authorization, prior approval or pre-certification. Pre-authorization means your provider contacts your insurance company to make sure your care is covered before you receive it. This is usually for additional services such as X-rays, CAT scans, referral to a specialist, etc…these prior authorizations are handled at your provider’s office by our referral nurses.
Preauthorization isn’t a promise that your care will be covered. Even if your care is preauthorized, your insurance company still needs to review the claim your doctor submits after your care is completed. Preauthorization helps you and your provider avoid unexpected healthcare costs.