Payment, Insurance and Billing
We know insurance and billing can be overwhelming and we are happy to help. We’ve gathered the information people need most here. Please review it to see if we’ve addressed your question. If we haven’t, or if you still need assistance, we’re here to help. Contact our Revenue Cycle Department at (855) 434-5714 for our Shelton, CT location or (855) 395-6457 for our Trumbull, CT location. We are open Monday through Friday from 7:00 a.m. to 7:00 p.m. CST.
Payment options for out-of-pocket costs
Payment for your visit and services is due at the time of service, including co-payments, co-insurance and unmet deductibles. If we are unable to provide you with the total for the portion of the visit that is not covered and that you must pay “out of pocket,” Essential Healthcare Group will bill you. Your payment is due in full when you receive the statement. There are several ways to pay:
- Set up and make an online payment here
- Send a check to: PO Box 305250, Nashville, TN 37230
How health insurance billing works
After your visit, Essential Healthcare Group will bill your insurance carrier on your behalf. In order to do this, we will need a copy of your insurance card with complete and accurate information of your health plan. We will also need your full name, address, phone number, date of birth and insurance identification number. If any of the information is incomplete or incorrect it could result in a denial from your insurance carrier. The accuracy of this information is the patient’s responsibility, therefore you could be held responsible for the balance if your carrier denies due to inaccurate or incomplete information.
The insurance carrier will notify Essential Healthcare Group of the amount of your visit that is covered by insurance and what is your responsibility (co-pays, co-insurance, or deductible amount). At that point, you will receive a bill for the balance. That balance is due as soon as you receive of the first account statement from Essential Healthcare Group. If any part of the balance becomes delinquent, then the account balance may be forwarded to an outside agency for collection.
Please note that the timeline for insurance processing varies by insurance company. You may not immediately receive a bill because of that. Do not assume that if you have not yet been billed, that there is no balance due.
Appealing or correcting a bill
Questions about outstanding balances
If there is a balance on your account after your insurance carrier has paid that portion, it means there are unpaid copayments, coinsurance, or unmet deductibles according to your benefit plan with your health insurance carrier. Please contact your health insurance carrier directly if you have questions about the health services that your insurance plan may or may not cover, or about any amount that they have assigned to you as “patient responsibility”.
If your insurance carrier or coverage changes
If your health insurance coverage has changed and may affect payment for services that have already been provided, please contact our Billing Department at (855) 434-5714 for our Shelton, CT location or (855) 395-6457 for our Trumbull, CT location. If the changes will only affect future services, simply provide your new health insurance card and information to us at your next visit.
Bills from other medical organization for tests or services ordered by Essential Healthcare Group providers
Your Essential Healthcare Group provider may have ordered medical services from another medical facility. The group completing the testing will bill you and your insurance separately from Essential Healthcare Group. Examples of items or procedures that you may receive a separate bill for include surgery, anesthesia, labs, hospital or surgery center, and any durable medical equipment (braces, crutches, etc.) If you have questions about the billing from non-Essential Healthcare Group medical facilities, please contact that provider using the information on the statement you received.
Diagnosis code questions or disputes
It is Essential Healthcare Group’s responsibility to ensure that the healthcare coding and billing that we submit to you or your insurance carrier accurately reflects the services that were provided to you during your visit. If you disagree with the billing, please contact us at (855) 434-5714 for our Shelton, CT location or (855) 395-6457 for our Trumbull, CT location. Note that coding is prescribed by others, and Essential Healthcare Group is required to follow these guidelines. We are very careful to follow all federal, state, and local coding and billing rules and guidelines.