MOGA BILLING 101

Participating Plans. MOGA participates in most major insurance plans in this area. We do not, however, accept TennCare or Arkansas Medicaid. Our providers at MOGA DeSoto do participate in Mississippi Medicaid. Our billing office is always happy to assist with questions related to billing and insurance. We do stress, however, that it is ultimately the patient’s responsibility to be familiar with her coverage and its requirements. Your insurance company will have the final word on whether or not a service is covered.

Understanding the Process.  After you see the physician, our billing office will file a claim with your insurance company. The claim lists each service that was performed, our charge for each service, and the diagnosis for each. Diagnosis is simply the reason we performed it. After your insurance company reviews and processes the claim, it will send an Explanation of Benefits (EOB) to both you and our office. The EOB again lists each service that was provided, along with how much was paid, how much was written off (adjusted), and how much is owed by the patient. All of these figures are based upon the insurance company’s fee schedule. A fee schedule is a list of every possible medical service, and what the insurance company is willing to pay for each. When a physician agrees to take your insurance, he also agrees to accept the payments outlined on its fee schedule. When a patient signs up to be covered by an insurance plan, she also agrees to pay the pre-determined amount that the company deems as the patient’s portion. This portion is called co-insurance. After we receive the EOB, our billing office will send you a statement, or bill, for the amount shown as the patient’s portion. We request that payment be made in thirty days, but are willing to make monthly payment arrangements as needed.

Laboratory Services.  In some cases, a test will be performed which requires a specimen to be sent to an outside lab. This is very common for physician offices. When this occurs, the lab will usually submit a claim to the insurance company. The insurance company will in turn send an Explanation of Benefits (EOB) to both you and the lab, and the lab will send you a statement. Questions about this bill should be directed to the lab’s billing department. This bill is completely separate from that of MOGA.

Payment Options.  MOGA accepts payments in the form of cash, check, and credit card. Cash payments should only be made in the office and should never be mailed. We accept the following credit cards: Visa, Master Card, American Express, and Discover. If you pay online, you also have the option of having your payment drafted from your checking or savings account.

FREQUENTLY ASKED QUESTIONS

What is a deductible? A deductible is a certain amount that some insurance company require the patient to pay before the company begins paying. For example: If your insurance plan has a $500 deductible, this means that you are required to pay the first $500 of medical expenses in full. After that, the insurance company begins paying.

What is a co-pay? A co-pay (or co-payment) is a flat fee that some insurance companies require the patient to pay each time she is seen by the physician. For example: If your insurance plan requires a $30.00 co-pay, this means that you must pay $30.00 up front each time that you see a physician. (It does not necessarily mean that you will not be responsible for other charges.)

What is co-insurance? Co-insurance is a percentage of the balance that some insurances require a patient to pay. For example: If your insurance plan requires a 40% co-insurance, and the final charge is $100.00, then your co-insurance amount would be $40.00.

What is maximum out-of-pocket expense? Maximum out-of-pocket expense is the most you will have to pay before all of your bills are covered. For example: If your insurance plan has a maximum out-of-pocket expense of $5000.00, this means that you should not expect to pay more than $5000.00 in personal medical expenses.

What do they mean by “in-network” and” out-of-network?”  Your insurance company does not have an agreement with every physician and hospital. Physicians and hospitals with an agreement are referred to as in-network. Physicians and hospitals without an agreement are referred to as out-of-network. If a physician or hospital is out-of-network, your insurance company will pay at a lower rate, and you will be responsible for a much larger portion.

What is a referral?  A referral simply means that your primary care physician (family doctor) has sent, or referred, you to a specialist. Some insurance companies will not cover a specialist unless this is done. Others do not require it. A few insurance companies may require a referral to an OB/GYN but most do not. It is very important to know your particular insurance company’s requirements.

What is an EOB?  EOB stands for Explanation of Benefits. After we submit our charges to the insurance company, the company processes them and lists each service and how it was covered on this document. It is then mailed to the patient and the physician’s office. The physician’s office takes then sends the patient a statement, or bill, based on how the insurance company has covered it.

CONTACT OUR BILLING DEPARTMENT

Pay Your Bill Online!  MOGA now accepts payments securely online. Save the stamp and avoid a trip!

Ask A Billing Question.  Log into our secure patient portal and submit a question about your bill.

Our mailing address for payments is: P.O. Box 1000; Department 375; Memphis, TN 38148-0375.
Our phone number is (901) 373-8790. Our fax number is (901) 202-8546.