CSSG Billing and Insurance
Frequently Asked Questions
The following is a list of frequently asked questions related to billing and insurance.
Do not hesitate to contact one of our patient account technicians if confused about
any part of your medical bill. Our billing office is available to assist you Monday
through Friday, 7 a.m.- 4:30 p.m. at (757) 668-8544.
Billing
Click on the question to view the answer.
- How do I know if my bill has been processed by my insurance company?
Answer:
The insurance company will send you an explanation of benefit (EOB) after your claim has been processed. The EOB will list the amount that CSSG billed the insurance company and the amount the insurance company has paid on the claim. It may also list the contractual discount amount and the patient responsibility. If your claim is denied, the EOB will also explain the reason for denial.
- I do not understand my bill. How do I know what has been paid and what is owed?
Answer:
Please
view our sample bill. It identifies each area of your bill, making it easy to find the information you are looking for.
- Why am I getting more than one bill for the same visit?
Answer:
Contact the billing office to discuss options. You may call during our office
hours Monday-Friday, 7 a.m. - 4:30 p.m. at (757) 668-8544.
- What should I do if I have questions about a bill?
Answer:
If you have a question about the way your insurance company paid or did not pay for a service listed on your statement from us, please call the claims or customer service number on your insurance card.
If you have a question about something else on your statement, please call the billing
office at (757) 668-8544.
- Why did I receive a hospital bill in addition to my surgeon's bill?
Answer:
When a child is hospitalized, you will receive several bills in addition to ours.
- Hospitals will bill for their charges related to your child’s stay, including your child’s room, equipment, medicines, laboratory and diagnostic testing.
- Other specialists and providers bill for services of their health professionals who treated your child.
As a general rule of thumb, you can always call the phone number listed on the bill or your insurance company if you have questions about bills related to your child’s hospitalization.
- Is there a penalty for not paying promptly?
Answer:
Yes. The easiest way to avoid additional costs is to pay the amount due on the statement within 30 days of receiving it. Overdue fees are subject to late fees. Fees due longer than 90 days may be turned over to a collection agency.
- Why am I now being charged for services I thought were free?
Answer:
As the practice of medicine evolves to meet the changing needs of families, our business practices must also change to reflect the nature of the services we provide. Therefore, we may exercise a modest charge for providing additional services. Some of these services may include: after-hour advice, non-payment surcharge, forms completion, etc.
- Why did I receive multiple bills for my family?
Answer:
Just as every child has his or her own medical record, every child has his or her own account number. That means you will get separate statements for each child.
- What happens if my account has been placed with a collections agency?
Answer:
Once an account is forwarded to an agency, you must contact the the agency to pay the balance. We no longer manage the account once it is forwarded. However, if you have questions about the actual services received, you should contact the billing
office.
- Can I set up a payment plan if I can’t afford to pay my bill all at once?
Answer:
Yes, you can. CSSG will work with you to establish a payment plan to meet your needs. Please contact our billing office Monday - Friday, 7 a.m.- 4:30 p.m. at (757) 668-8544.
- My account has been referred to a collection agency or collection attorney. How do I resolve this issue?
Answer:
CSSG will refer accounts to collections only as a last resort from an inability to communicate with a family. We send bills out at regular intervals with escalating urgency to highlight the importance of contacting us.
If we are unable to contact you after 3 months, we must send the bill to collections. We view the collections process as a last resort and would much rather evaluate your situation and determine if payment assistance is needed.
A physician billing representative is available to assist you with this process
Monday - Friday, 7 a.m. - 4:30 p.m. at (757) 668-8544. In the event that your account has been referred to a collection agency, we ask that you first contact the collection agency handling the account to make payment arrangements.
Insurance
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- How do I know if you participate with my insurance?
Answer:
Review your plan directory or contact your insurance to make sure our physician(s) participates with your insurance.
- Will you bill my insurance?
Answer:
As long as our facility participates with your insurance company, we will file the claim as a courtesy to you. If we are not participating, we will provide you with a receipt for services for you to file your individual claim, if necessary.
- What is the difference between an HMO and a PPO?
Answer:
An HMO is a legal corporation that provides health care in return for pre-set monthly payments. For most HMOs, members must use the physicians, hospitals and other health care professionals in the HMO's network in order to be covered for their care.
A PPO is a network of contracted doctors and hospitals that provide health care services at a pre-negotiated lower price. Members receive better benefits when they use network providers, but have the option to used out-of-network providers for higher out-of-pocket costs.
- What is the difference from "in-network" and "out-of-network" providers ?
Answer:
Health care providers and facilities contracted to provide services with your health plan are called "in-network” providers. You will greatly reduce the cost of your medical care by getting all services from your “in-network” providers. Your health plan should provide you with a list of these. All other providers are considered "out-of-network." Receiving care from these providers and facilities will increase your out-of-pocket costs.
- How do I know if a referral or pre-authorization is necessary?
Answer:
Review your benefits booklet or plan reference material for guidance. Otherwise, contact your insurance plan at the number listed on your insurance card.
- I don't have insurance, what are my options?
Answer:
There are several organizations able to provide assistance based on financial status. Locally, the Center for Pediatric Research (CPR) works in conjunction with FAMIS to provide such a service.
A FAMIS application is available below for your convenience. Print and complete section 7 of the application and submit it to the CPR. You may also drop it off at any of our CMG practice locations. A FAMIS representative will then contact you to answer questions and complete the application process.
- What if my child does not currently have health insurance?
Answer:
Please contact one of our health benefit analysts to evaluate your child's eligibility for health insurance programs. Their office is located near the front entrance of the hospital and their office hours are Monday - Friday from 7 a.m.- 9 p.m. You may also call them Monday - Friday, 8 a.m.- 5 p.m. at (757) 668-7202 and 5 p.m. -
9 p.m. at (757) 668-7682.
- I belong to an HMO and my child went to the emergency room for care, what should I do?
Answer:
An HMO has strict guidelines for seeking service outside your Primary Care Physician. Customarily, referrals and/or authorizations are required in order to pay the claim or you may be personally responsible. Make sure you coordinate the issue through your PCP within 24 hours of your visit.