FAQ's

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FAQ's •

FOR PROVIDERS

  • Schedule a consultation to discuss the needs of your practice. After the consultation, we will send you an email requesting additional information about your practice along with a service agreement. Once the requested information is returned, services can begin!

  • Yes, your clients can contact us directly for more information about our services.

  • Contracting is required for claim submission services. However, your clients can verify their benefits and receive invoice preparation services without you being contracted.

  • Yes, we have worked with midwives, birth centers and insurance companies for years. We’re happy to discuss the services you provide to your clients and determine a fair price.

  • Ordinarily medical records are not required, but sometimes they ask for additional information to clarify anything they deem questionable.

    We recommend clearly documenting all services provided to your clients. This is best practice for your business and comes in handy if it’s ever requested.

  • If you are in the insurers system, the check can be mailed directly to you, however, it depends on the insurers policy. Every insurer handles reimbursement differently and they will not always allow us to specify where we would like the check mailed. If the services were not prepaid and the check is mailed to your client, your client will be responsible for disbursement of funds.

FOR provider CLIENTS

  • To receive claim submission services, your provider must be contracted with True Healthcare Billing. We offer options that don't require any fees from your provider. If your provider does not have a biller, please refer them to us.

  • Claims should be filed after all services have been rendered.

  • We recommend choosing a preferred provider organization (PPO) plan that has a low deductible and co-insurance. Please make sure the plan does not have exclusions for home births, midwives and/or birth centers.

  • We recommend applying for a Gap Exception. If approved, the services you receive from an out of network provider will be priced and paid at the in network rate.

    To get a Gap Exception approved, you’ll be required to prove that in-network providers are incapable or unwilling to provide the services you’re pursuing, the services are medically necessary and they are covered by your plan.

    Alternatively, you can use your out-of-network benefits.

  • Most insurance companies have a 90 day filing deadline. Some insurances allow up to 12 months. We recommend completing a Verification of Benefits or reviewing your policy to understand your options.

  • Insurance payors have an “allowable amount” that they won’t reveal to out-of-network providers, prior to submitting the claim because it’s considered “proprietary information”. However, the reimbursement can be calculated by subtracting your deductible from the allowed amount and multiplying it by the co-insurance.

    EXAMPLE: Your allowed amount is $2500, deductible is $500 and co-insurance is 20%.

    $2500-500 = $2000. Since your coinsurance is 20%, your insurance will pay 80% of $2000. $2000 x .80= $1600. $1600 would be the reimbursement amount.

  • It depends on the insurance payors policy. Every insurer handles reimbursement differently and they will not always allow us to specify where we would like the check mailed. If your services were prepaid and the check is mailed to your provider, your provider will be responsible for disbursement of funds.