The Patient Financial Services Department can help you with any questions you have about statements, billing or insurances. Just call the department directly at (951) 665-1100, 9-12pm, 2-5pm M-F.
Patients are required to pay for services when they are rendered.
As a service to you, if you have medical insurance we will bill your insurance company. We accept assignment of benefits for most insurance plans. SJ Medical Group is contracted with several managed care plans, preferred and exclusive provider organizations, and private insurances. You are responsible at the time of the visit for any copayment, coinsurance, and charges not covered by your insurance company.
After charges are processed by your insurance company, you will receive a statement from our office indicating any balance due. Payment of the balance is expected within ten (10) days of the billing date on the statement.
We do our best to verify your insurance coverage and limitations. However, you are responsible for keeping us up to date on any changes to your plan or policy. Please inform us of any changes to your insurance coverage.
It is also very important that you inform us of any change to your address, telephone number, or employment.
Frequently Asked Questions and Answers about Statements
I am covered under a HMO, why am I getting a bill?
Although most medical services are covered under an HMO plan, there are some services that are classified as non-covered services. Each plan defines what those non-covered services are, and describes them in the information given to each plan holder. It is the responsibility of the plan holder to understand their benefits.
I paid my co-pay at the time of my visit, why did I receive a statement in the mail requesting payment?
A statement may be generated before the co-pay is posted to the patient’s account. Payments are posted at a central site, and there are situations where that day’s payments were not posted before the statement was generated.
Why didn’t my physician advise me that my physical would not be covered under my insurance plan?
There are hundreds of different plans with hundreds of variations as to the benefits offered. Our physicians have no way of knowing each patient’s coverage. It is the responsibility of each patient to know their individual coverage.
Most insurance plans will not cover sports, school, DMV or employment physicals. If you are seeing your physician for this type of physical, you will need to be prepared to pay for the visit.
Why does it take so long to receive a statement?
If a patient is covered under an insurance plan, a claim is generated within a few weeks of the time the medical services were received. Claims are sent either electronically or by paper, depending on the capabilities of the insurance plan.
If a patient has a secondary insurance, the secondary insurance cannot be billed until the primary insurance pays their portion. A claim form is then generated, the Explanation of Benefits from the primary insurance is attached to the secondary claim, and the claim is sent, via paper, to the secondary insurance. It can take up to 90 days before the secondary insurance pays the balance of the claim.
If there is a portion left over that is the responsibility of the patient, a statement is generated. This could be 6 months to 9 months before all of the above activity is completed.
Why can’t Patient Financial Services change my diagnosis so my insurance plan will pay for the service?
Only physicians can diagnose patients. It is illegal to create a diagnosis just to satisfy an insurance company.
Why did I receive a bill for a co-pay for my x-ray services?
Many health plans have a separate co-pay for ancillary services, such as x-ray and laboratory testing. The benefit information from your health plan should inform you if your coverage requires a co-pay for these ancillary services. Check with your health plan.
If you were billed by SJ Medical Group and your health plan does not require a separate co-pay for your ancillary services, contact our Patient Financial Services department and they will adjust your account.
Why does my statement, at the bottom, show an un-applied or prepayment?
SJ’s patient accounting system is defined as a line item system. All charges are detailed out and all payments are applied against individual charges. When a payment has been received and no charge has yet been posted, that payment will show as either prepayment or an unapplied payment. When the appropriate charge is posted to your account, the prepayment or un-applied payment will be matched to the charge.
Why can’t SJ bill my secondary insurance for my lab charges?
SJ Medical Group does not perform laboratory tests in house. We have contracted with XXXX Laboratories to perform our laboratory testing. All billing for this testing is done by XXXX. Since SJ Medical did not bill the primary insurance, we cannot bill the secondary. You, as the patient, can send a bill to your secondary insurance.
What is my deductible?
SJ Medical does not have access to your individual benefits. Your benefit information will tell you the amount of your deductible. You can call the number on your insurance card and they will be able to advise you of your deductible. They can also tell you if you have satisfied your deductible for the calendar year.
Why was I billed for my newborn’s charges?
No insurance will add your newborn automatically. It is your responsibility to inform your insurance company to add your newborn baby. Most insurance companies will give you 30 days after the arrival of your newborn to add them to your coverage. However, not all plans will retro your coverage back to the birth. Always check with your insurance company for their requirements.