Frequently Asked Questions

Frequently Asked Questions

I received a statement from my doctor and I think my insurance should have paid this bill, what should I do?

Look carefully at your bill for the explanation of how your claim was processed. You  should also have an Explanation of Benefits/Payments from your insurance company that you can review.  You will only receive a bill from our physicians if your insurance company has left you with the responsibility. This occurs if you haven’t met your deductible, have a copay and or coinsurance that is your responsibility, if the service is not covered under your contract or you have not met your obligations under the terms of your insurance contract. If you feel the insurance company should have paid, you will need to contact them for review and payment. Otherwise, the bill is your responsibility and you should make prompt payment to your physician.

I received a bill from the laboratory for my pap smear, why am I receiving this when the pap smear was done in the office?

The pap smear retrieval is done by your physician in the office but the specimen is sent out to a laboratory to be viewed under a microscope by a trained pathology professional. They bill separately from us and should be sending your claim to your insurance company for payment, if you disagree with the bill they sent you, then contact the laboratory at the phone number on the bill. 

I received a bill from my physician because the service was not covered in my insurance contract. I spoke with my insurance company and they advised me to ask you to code the claim differently so it will pay. Can you do this?

No, under no circumstances can a physician “code” a  noncovered service in a way just to get it paid, that is considered insurance fraud. If you were seen for a reason other than what was billed or you feel the service billed needs to be reviewed, please call us and we will have the physician review the visit and verify the services billed.  Keep in mind that a change will be made only due to error; if no error exists you will need to pay this bill.

How does my deductible affect the payment the insurance company makes to my doctor?

If your deductible has not been met the insurance company will not pay the doctor until it has been. Once it has been met the physician will be paid based on his contract with your insurance company, if one exists, or based on the insurance allowed amount minus any copays or coinsurance (that would be your responsibility).

I was recently in the hospital for surgery and paid the bill sent to me by the hospital. Now I have received a bill from my doctor. Why am I getting a bill from my doctor? I thought this was all part of the hospital bill.

The hospital bills separately for services provided by the facility and its staff, the doctor is not paid by the hospital but simply has privileges to perform services at the hospital.  Therefore, you should expect to receive a bill for the doctor’s services .  You will probably also receive a bill from any other physician that provided services for your care (i.e. Anesthesiologist, Radiologist, Pathologist).

PCL is an industry leader in medical billing services serving Jacksonville, Florida clients as well as statewide. Professional Claims Link bills insurance and patients on behalf of clients in the state of Florida and is working towards a national presence in the medical billing industry. Experienced medical billing services that include billing specialties in Obstetrics and Gynecology, Urology, Radiology, General Surgery as well as many others. Professional Claims Link uses all its resources in order to rise above the other medical billing companies and become an authority and leader in the medical billing industry. Contact PCL, we can help you decide if outsourcing the medical billing responsibilities is right for your practice. If you already have a handle on it, we can perform an inhouse audit and find those areas where improvement can be made. Let us improve your efficiency and effectiveness. Let us help you to get on board with the latest technology that will improve the flow of your office and reduce time spent on redundancy. Medical billing is a complex field and needs an expert, not just a clerk, we are experts at PCL and would like to discuss what we can do to bring in every collectable penny you have worked so hard to make.