Frequently Asked Questions

What is Coinsurance?

A percentage of the charges that you pay for covered services. For example, a 20 percent coinsurance on a $200 procedure means you pay $40.

What is copayment (copay)?

The set amount you pay for covered services, usually collected at time of
service. For example, a $10 urgent care visit copay means you'll pay $10 for each urgent care visit.

What is a Deductible?

The amount you pay for covered services each year before your insurance
starts paying. Depending on your plan, you may pay copays or coinsurance for some services without having to reach your deductible. Until you reach the deductible, you will pay the full charges for most services.

I paid when I checked in for my appointment. Why did I get a bill later for additional charges?

What you pay at check-in cost may only cover part of what you owe,
especially if you get additional urgent services (like a blood test or an X-ray) after seeing you, so the actual cost of your visit may be higher. If there are any additional charges, you’ll get a bill for the difference later.

Can I pay my bill online?

Yes. You can securely pay your bill at temecula24hoururgentcare.com and
sanmarcos.care. Click the Payments page, then select make a payment.

What’s the difference between a bill and my Explanation of Benefits (EOB)?

The EOB is not a bill. It's a summary that shows the services you
received, how much they cost, and how much your health plan paid. Use it to keep track of your expenses, your deductible, and your out-of-pocket
maximum. That way, you can see how close you are to reaching those
limits. It may take about 30 days for services to show up on your EOB.

I have multiple health insurance companies. How Do I know who to bill?

Coordination of benefit rules apply. Contact your provider to help in determining the proper order of billing. Example: Birthday rule may apply

Why aren’t all services covered by my insurance company?

Under any plan, there may be services that are not covered because the insurance company may consider them routine or unnecessary. If you disagree with the decision, you should contact your insurance company for more information.

Why did I receive a bill?

There are many reason you may have received a bill, below are a few of the most common:

*Insurance is applying amounts to your deductible, coinsurance, or copay may have increased

*coverage has lapsed

*services are non-covered

*Insurance is requesting additional information

*No Authorization 

What is Prior Authorization?

Under your plan, certain service and equipment may need approval from your health plan first before they’re covered. The services and equipment requiring prior authorization are described in your plan documents. This is usually if you have an HMO plan, however Urgent cares typically do not require this.

 

If your insurance denies your claim, you have rights. We at the Patient Advocacy Center are here to help, fight against your insurance for the care you received. You can file an IMR claim online by following the steps below.

The Department of Managed Healthcare:

How to file an Independent Medical Review On-Line:

 

Please go to the Department of Managed Care website: 

Website: https://www.dmhc.ca.gov/FileaComplaint.aspx

Medical Review form: https://www.dmhc.ca.gov/Portals/0/Docs/HC/RevisedIMRComplaintFormENGLISH_1.pdf

To speak to a representative call DMHC Help Center 1-888-466-2219

When you do this the reviewing agency will send us a request for medical records and our information. We will provide them with the necessary information. By submitting a claim we will know that this bill is being disputed by you and we will not go forward with collections. If at any time you have questions or need help PLEASE call me, if I am not available leave a message. I am here to help you and will do all I can to assist you in this matter.