Billing & Insurance FAQ
IF I HAVE A QUESTION ABOUT MY BILL OR HOW MUCH MY PROCEDURE AT ALTA ORTHOPAEDICS WILL BE, WHO SHOULD I TALK TO?
Please call the Alta Billing Department at (805) 963-9377. We are available to assist you Monday-Friday from 8AM-5PM.
What is my FINANCIAL RESPONSIBILITY FOR OFFICE VISITS AND SERVICES?
The patient responsibility is dependent on all applicable co-pays, co-insurance and deductibles for services provided at the time of the office visit. There may also be a yearly deductible or cap on some services. Our office files an insurance claim as a courtesy to you. For non-covered services payment in full is the responsibility of the patient.
What is a “co-payment”?
A co-payment (often called “co-pay”) is a set fee that the insured person pays to providers at the time of service. Co-pays are applied to emergency room visits, hospital admissions, outpatient surgeries, office visits, etc.
What is a “deductible”?
Deductibles are provisions that require the insured person to pay a specified amount before insurance benefits are provided. For example, if your policy has a $500 deductible, you must accumulate and pay $500 out-of-pocket before your insurance will begin paying a percentage of service charges. Once you have accumulated and paid your $500 deductible to your medical providers, your insurance plan will start paying a percentage of future medical bills. You are thereafter responsible for your coinsurance. Deductibles typically re-set annually.
what is co-insurance?
Co-insurance is a form of cost sharing. After your deductible has been met, your insurance plan will begin paying a percentage of your bill. After your insurance has processed the claim and paid the percentage determined by your plan benefits, you will owe the remaining percentage, or “co-insurance.”
WHAT ABOUT A POINT OF SERVICE PLAN OR OUT OF NETWORK PPO?
There may be higher out of pocket expense, which includes deductible, co-pay and co-insurance.
What do the terms “in-network” and “out-of-network” mean?
If you have selected a PPO plan, you will have both in and out of network coverage. Healthcare providers that participate in your health plan are often referred to as “in-network,” and providers that do NOT participate in your health plan may be referred to as “out-of-network.”
DO YOU TAKE MEDICARE?
As of January 1, 2008, we are participating providers in Medicare. Per Medicare rules we will ask you to sign a Medicare ABN form (Advance Beneficiary Notice of Noncoverage) for services not covered by Medicare.
If you have Medicare Advantage or Medicare C plan, this gives the beneficiaries the option to receive benefits through private health insurance plans. These Private Fee for Service (PFFS) plans vary and you should call the customer service line to clarify your co-pay, co-insurance and deductible amounts.
what if i don’t have insurance?
Payment in full is requested at the time of visit.
Will Alta Orthopaedics submit claims to my primary and secondary insurance?
As a courtesy to our patients, we submit claims to your primary and secondary insurance companies. We will do everything we can to advance your claim, and will contact you if we need your involvement in the process.
What is an “Explanation of Benefits” (EOB)?
An EOB, or Explanation of Benefits, is a letter from your insurance company that provides information about how insurance processed your claim. If you have any questions about your EOB, please call Alta.
What should I do if the insurance company sends payment directly to me?
If you receive a check from your insurance company, please immediately call Alta at (805) 963-9377. We will ask you to endorse the check to Alta and send it directly to our office. It is very important that you endorse this check immediately to Alta: it is money due to the office for your visit and is not to be used for any other purpose.
How and where can I pay my bill? What forms of payment are accepted?
You can pay:
By telephone with a credit or debit card by calling MedBridge at (805) 963-9377
By mail by sending your billing statement and payment (by check, credit or debit card) to Alta Orthopaedics, 511 Bath Street, Santa Barbara, CA 93101
In person at Alta Orthopaedics (by cash, check, credit or debit card)
Online through our Bill Pay portal
Are you contracted with my insurance?
To find out more about insurance contracts (including worker’s comp), please visit our Insurance Contracts page.