The following is some information to help you understand how insurance works, and how to make sure that your visit to our office is paid for by your insurance.

Insurance terminology:

"deductible":  Almost every insurance policy requires that the patient meet a "deductible" amount before insurance pays anything.  The patient is billed by the physician for his fees until all fees billed by all of the patient's providers adds up to the deductible amount.

The physician is paid nothing for his services unless the patient pays the deductible amount to the physician. 

"co-pay":  Insurance polices usually require that the patient pay the physician an amount for every visit.  Dr. Shiffman is typically considered to be a primary care physician, rather than a specialist, for purposes of the co-pay amount.

"co-insurance":  Most insurance policies require that the patient pay some portion of a physician's fees even after the deductible is met and the co-pay has been paid.  For example, a 80%/20% policy means that the insurance company pays 80% of the physician's fees, while the patient must pay 20% of the fees, after the deductible and in addition to the co-pay.  The portion that the patient pays is called "co-insurance."

"EOB":  This is the "explanation of benefits" that the patient and the physician receive from your insurance company for each office visit, explaining what they paid for, what they did not pay for, and why.

"DOS":  Date of service.  This is the date of your office visit.

The physician's write off:  When a physician agrees to accept a patient's insurance, he agrees to discount his rates in exchange for the insurance company sending its customers to the physician.  If you have insurance with a company that we accept, we write off part of every charge, including for the charges that you pay as part of your deductible.

You, the patient, are responsible for knowing what your health insurance policy pays for and does not pay for.  Your visit was coded according to what you told Dr. Shiffman your insurance covers.

Please note that it is very difficult for us to go back a month after your office visit to change the diagnosis or procedure codes.