Understanding Your Responsibilities

It is important to understand your payment responsibilities for your insurance plan. We understand the payment process can be confusing for members, so we’ve outlined the payment steps below and what you are responsible for. Our ClearChain Member Support team is always here to help guide you through this process, answer your questions and troubleshoot for you when you need help.

Understanding What You Pay As a Member

You are responsible for paying:

  • Your insurance premium, which is deducted from your paycheck.
  • A co-pay at the time of service or at your office visit. Do not pay any additional money at your office visit besides the co-pay.
  • The amount owed under Patient Responsibility on your Explanation of Benefits (EOB). This amount goes towards your deductible.

 

 

Understanding Your Explanation of Benefits (EOB)

After a doctor or hospital visit, we will send you an EOB. This EOB is not a bill. It is a statement that lists the health procedure you received and explains the total amount billed, what your health insurance plan paid, and what you owe towards your deductible. 

Review your EOB.

When you receive your EOB, be sure to read it carefully and identify the amount listed next to Patient’s Responsibility. This amount is what you are responsible for paying.

Compare your EOB with the bill from your provider.  

Compare the amount listed next to Patient’s Responsibility on the EOB with the amount owed on the provider’s bill. They should be an exact match. 

For example, if your Patient’s Responsibility lists $5.97, the provider’s invoice should also list $5.97.

If the amount is an exact match, pay the amount owed.

Pay the provider the amount you are responsible for by the payment deadline. If you can’t pay the entire bill, set up a payment plan with your provider. It is your responsibility to pay these billed charges.

If the amount is not an exact match, contact us.

If the amount on each document is different, the provider or hospital may be attempting to collect additional money directly from you. This is called “balance billing.” Give us a call at 833-733-8478.

Understanding Balance Billing

Simply put, a balance bill occurs when a provider or hospital attempts to charge you more than what ClearChain Health has already paid them. The “balance” sought to be collected against you will match the “discount” determined by your plan as shown on the EOB. 

For example, if your Patient’s Responsibility lists $5.97, but the provider’s invoice shows that you owe $105.97, you are only responsible for the $5.97. The additional $100 the provider is charging may be balance billing.  

Through our claim review and audit program, we determine the fair and reasonable costs for the medical services you receive. Then we pay your provider that amount for your treatment. You are only responsible for your insurance premium, co-pay, and deductible as listed above. 

What to Do if You Receive A Balance Bill

If you receive a bill for anything beyond your responsibility, immediately call our Member Support team at 833-733-8478. We will work with your provider to dispute the excess amount billed and defend you against unfounded collection activity. 

Frequently Asked Questions

Should I pay more than my co-pay at my doctor’s visit?

Only pay your co-pay. You are only responsible for your co-pay at the time of service or treatment.

Why do I need to read my EOB?

Your EOB tells you lots of important information about the financial side of your procedure or visit. You should read each EOB you receive to make sure you know the Patient Responsibility that you are obligated to pay.  And, if that amount differs from the statement you receive from your doctor, the difference may be considered balance billing. 

What should I do if I get a bill saying I own more?

This difference may be considered balance billing. Contact our Member Support team immediately at 833-733-8478 and we will help.

Do I have to pay what my company doesn’t pay? 

Just pay your premiums out of your paycheck, your co-pay and the amount listed next to Patient’s Responsibility on your EOB.

What happens if there is a dispute about the difference owed?

In the event there is a dispute following payment, ClearChain Health will work directly with the facility or provider to understand their position and resolve this matter. We will defend you and your plan against unfounded collection activity. You are not responsible for the amount in excess of your patient responsibility.

You are protected by state and federal debt collection laws. In the event a member experiences a violation of these laws, ClearChain will provide the necessary defense and guidance. 

Is my provider balance billing because ClearChain doesn’t pay them enough?

Just like every health insurance program and carrier, ClearChain determines the fair and reasonable costs for the medical services you receive. Then we pay your provider that amount for your treatment. We determine these fair costs through a comprehensive claim review and audit process.

Member Resources

Getting Started with ClearChain Health

Learn the easy steps you’ll take to start using ClearChain Health and how we’ll help you navigate the process.

Nominate Your Provider

Learn why it’s important to nominate your provider to participate, how to do it and our role before your next visit.

Member Support

Learn how we help with balance billing, chronic disease management and hospital admissions.