Billing

Clinics billing

Call us with questions
If you have questions about a clinic bill, please call our Customer Service office at 651-232-1120 or 866-770-6412 (toll-free). Our staff deal specifically with billing concerns for HealthEast Clinics.

We are here to take your calls Monday through Friday from
7:30 am to 4 pm.

Submit questions online
Click here to submit your Clinics billing questions online. A billing specialist will respond by phone within three (3) business days, between the hours of 8 am and 4 pm.

Billing for wellness visits/preventive care

Preventive care is also known as wellness visits or routine physicals. This type of visit may result in two separate charges if the visit contains both preventive care and care for a problem or illness. This could also cause two separate co-pays. This is called "split-billing."

Why could I be charged two co-pays?

Charges for a patient visit must include everything that happened during the visit. If the visit includes both a wellness visit and care for a problem or illness, the charges must reflect all of the care provided. Please understand that we are legally required to bill your insurance company using accurate information. This must include all of the care you received.

The charges for a visit that includes both wellness care and care for a problem must be broken into:

Your preventive or wellness examination, which includes a history and other questions related to your overall health
and well-being and
The care related to your illness or problem, with questions related to the history of your problem or illness.

The result is that your insurance company may view this as two visits instead of one. This means that you may be responsible for a co-pay for your wellness visit and a co-pay for your illness-related visit. This also depends on your insurance benefits.

Below are some examples of when this might happen.

Say that you are a 40-year-old in good overall health. You are coming in for an annual physical. However, you have had shoulder pain for several weeks as a result of playing basketball. During your visit, your clinician completes the annual physical. She also spends additional time taking a history of the shoulder pain, examining the shoulder and associated area. She determines that you have an acute shoulder injury.
Another example might be that you are a 62-year-old who has asthma. You are scheduled for your yearly exam. Lately you have been wheezing. You also have a lot of questions about your medications. Your clinician performs the annual examination. He then spends additional time focusing on your asthma. He answers your questions, adjusts your medications, and recommends asthma education classes.

In the two examples above, your clinician would bill your insurance company for the routine physical. Because of the additional work provided to assess the shoulder and the asthma, your clinician will also bill your insurance company for an illness-related visit. In these situations, you may be responsible for paying a co-pay and/or deductible for two visits, based on your insurance benefits.

May I request a change in the coding for the care provided to me?

Coding must reflect what happens during your medical visit. It must match what is in your medical record. Appropriate and accurate
coding is a federal legal requirement.

Sometimes a patient is told that if a different code had been used, they would have coverage for a specific procedure. However, it is considered fraudulent to change codes solely to get a service
covered. It is very important to understand your coverage so that you will not be surprised if a specific type of service is not covered by your policy.

What preventive care is covered by Medicare?

Medicare covers the following care on a periodic basis. Further information on Medicare coverage is available at www.medicare.gov/health/overview.asp

Tests for breast cancer, cervical cancer, vaginal cancer and colorectal cancer
Bone mass measurements (DXA Scan)
Diabetes monitoring and self-management
Flu, pneumonia and Hepatitis B shots
Prostate cancer screening, including digital rectal exam and prostate specific antigen (PSA) test

If you have question, you can always contact your insurance company’s member care department. They can assist in answering
all questions related to your benefits. If you have Medicare, you can contact the Beneficiary Care Department.