Patient Billing FAQ

We know healthcare billing can be confusing, but you don’t have to figure it out alone. Get clear, straightforward answers about insurance coverage, out-of-pocket costs, and payment options.

How long will it take to receive my bill?

If you are using insurance, it can take insurance 4-8 weeks to receive your bill. After your healthcare provider completes their documentation or notes from your appointment, your appointment information is sent to a coding specialist to apply medically appropriate procedure and diagnosis codes based on the provider’s notes. This coded claim for your appointment is then submitted to your insurance provider. Insurance will process the claim according to your specific plan benefits to determine what your insurance will pay towards the visit and what your patient responsibility (or amount due) will be. Insurance will then send the finalized claim back to your healthcare provider. At the same time, insurance will send you an Explanation of Benefits (EOB) to let you know how your appointment was processed, the costs associated with the visit, and who has the responsibility for those costs. Tia will send an emailed bill to you with your amount due. At any time after your appointment, you can see the “status” of your claim (if it has been submitted to insurance, if it is still being processed by insurance, or if it has been finalized) in your Member Portal.

If you are paying cash or out-of-pocket, it will take 2-4 weeks to allow time for your provider to complete their documentation or notes from your appointment, and then time for your appointment to be coded. Once your appointment is finalized, Tia will send an emailed bill to you with your amount due. At any time after your appointment, you can see the “status” of your claim in your Member Portal.

What is the patient billing process like for patients?

Tia does not collect copays or costs at time of appointment to allow time for appointment information to be reviewed before it is sent to insurance or billed to you. Once an appointment is ready to be billed, you will receive an emailed copy of your bill.

You will have 30 days to review the bill and to ask any questions, etc. you may have. You will receive a weekly reminder email letting you know about your balance. At any time, you can pay your bill directly through the email or patient portal. After 30 days, your payment method on file will be charged. With Tia’s Predictable Payments, you will not be billed more than $100 at a time for larger bills.

Patients can pay with credit or debit card, FSA/HSA, or Apple Pay.

How much will my visit cost?

Appointment costs can vary, the biggest factor depending on your insurance plan and specific benefits. If you have insurance coverage that is in-network with Tia, your insurance provider will determine how much you will owe for a service depending on your insurance plan and benefits, whether that is a copay, or an amount towards your in-network deductible. Your Care Team at Tia can help provide estimates and assist as you navigate through your insurance benefit information. You can message your Care Team directly through the Member Portal.

For estimates of Tia's cash rates (discounted charges for uninsured patients), you can visit Tia’s Service List.

Can I get a cost estimate before an appointment?

Of course! In order for our team to provide you with the most accurate estimate, we will need details of your upcoming appointments, such as the type of visit and the reason for your visit. For example, if you are having a telehealth visit for a medication refill for anxiety or an acupuncture appointment for chronic migraines, the type of visit and the reason for the visit can impact how insurance will cover the visit and the possible cost. If you need an estimate for a procedure like an ultrasound, please obtain the procedure codes (or CPT codes) from your provider so we can provide an accurate estimate. Our team will need at least five business days prior to your appointment to provide an estimate, which you can request by messaging your Care Team directly through the Tia Portal.

Estimates are not a guarantee of cost, but our team will do everything possible to ensure you have a clear understanding of the potential expenses involved. Please note that Tia is providing only an estimate and the final cost may vary based on your insurance coverage, deductible, copay, or out-of-pocket maximum, and some costs may not be covered if they fall outside of your plan’s network or coverage criteria. If you have any questions or need assistance navigating your insurance benefits, our team is happy to help guide you through the process.

What does it mean to be in-network and how does it impact cost?

In-Network refers to healthcare providers that have a contract with your insurance provider. The contract allows certain negotiated/discounted rates for healthcare services. Patients will typically pay less with an in-network provider when using insurance.

Your insurance provider will use a number of factors to determine if a provider is in-network. The address your provider and clinic are located can determine network status. For example, Dr. Avery might be in-network with your insurance plan at 100 Main Street, but her clinic on 100 2nd Ave is out-of-network. The service you receive will also determine network status. For example, your insurance might be in-network for primary care and gynecology but is out-of-network for acupuncture. While Tia receives benefit summary information from most insurance providers, it is always important to check with your insurance provider personally to have a complete understanding of your benefits. Tia’s Care Team is always available to help you navigate network status for providers or specific services prior to appointments if you message in the Member Portal or call directly.

What is a Copay?

A copay is a fixed amount you pay for a specific service or procedure. For example, if your plan has a $20 copay for a doctor's appointment, you’ll pay $20 regardless of the total cost of the visit. Some insurance plans will not have copays or will only have copays for certain services or appointments. For patients that have a copay for Primary Care and Specialists, this does not mean that all of their services are covered by a copay. For example, patients who have a copay plan will likely still pay towards their deductible or coinsurance for procedures like lab work, imaging, or surgery.

What is a Deductible?

A deductible is the amount you must pay out-of-pocket for healthcare services before your insurance starts to cover its share. A patient will pay 100% of the contracted rate between insurance and provider for a specific procedure or service until the deductible is met. For instance, if your insurance has a rate of $200 for a mental health visit, you would pay the full $200 (until your in-network deductible is met).

What is Coinsurance?

Coinsurance is the percentage of costs you pay after you’ve met your deductible. For example, if your coinsurance is 20%, and you’ve already met your deductible, you will pay 20% of the remaining costs for covered services, while your insurance pays the other 80%. So, if your deductible has been met in full and a procedure costs $100, you’d pay $20, and your insurance would cover $80.

What is a High Deductible Health Plan (HDHP)?

A High Deductible Health Plan (HDHP) is a type of health insurance plan characterized by higher deductibles and lower premiums compared to other health plans. HDHPs require you to pay a higher amount out-of-pocket before your insurance starts to cover costs. For 2024, the IRS defines a high deductible as at least $1,600 for individual coverage and $3,200 for family coverage. Many patients will choose a health insurance plan with a lower premium (monthly rate). While these plans are less costly month to month, basic care will usually cost significantly more than a copay.

You will pay the full contracted rate (or allowed amount) set by your insurance company for all appointments towards their deductible. Once your deductible is met, insurance will start paying towards your care. These visits are still considered covered and in-network, but they are covered by your deductible.

What does it mean if something is covered by my insurance?

A covered service means that a specific service or procedure is covered by your insurance according to your benefits– and payment by you goes towards your copay or deductible. It (unfortunately) does not necessarily mean that insurance pays 100% of the charge.

How does Tia determine how much to charge my insurance provider?

Like most healthcare providers, Tia uses a number of factors to determine costs and charges:

• Market Rates: Providers also take into account the prevailing market rates for similar services in their geographic area. This helps ensure their charges are competitive and align with what other practices are charging.
• Regulatory Guidelines: Certain procedures may have specific guidelines or limits set by regulatory bodies or insurance companies that impact how charges are determined. The Centers for Medicare & Medicaid Services (CMS) fee schedule plays a significant role in determining healthcare costs and charges. The CMS fee schedule establishes standardized payment rates for various medical services and procedures. Many healthcare providers and private insurers use the CMS fee schedule as a benchmark, impacting overall healthcare costs.
• Cost of Services: Healthcare providers consider the costs associated with delivering the service, including overhead expenses like staff salaries, facility costs, equipment, and supplies.

Is preventive care covered 100% by insurance?

A number of factors determine how insurance will cover your preventive care, such as if the provider you are seeing is in-network, if your insurance plan offers preventive coverage generally or for a specific service, or if the care you are receiving is truly preventive. You can read more about preventive care here.

Are any appointments mandatory or required to be a Tia patient?

No appointments are required for you to be a patient at Tia, but your healthcare and wellness journey are unique to you– and we will work to give you the best information possible to decide when and how you need to be seen for care. There may be times when a visit is required to receive medication, consultation or treatment. This is to ensure we can best care for you and to comply with regulations that ensure an appropriate provider: patient relationship is established. We are here to partner with you on your healthcare journey - both in clinic and virtually and want to see you for a visit when you need us and are available to support you via chat when that is clinically appropriate.

What is Predictable Payments?

Navigating healthcare in America can be a daunting and often unpredictable experience. The complexities of insurance, unexpected medical bills, and the stress of managing these expenses can take a toll on anyone. While we can’t control how insurance companies operate, one thing we can control is how we charge for services. At Tia, we understand these challenges, and we’re excited to introduce a new method of paying for healthcare that aims to bring ease and predictability to our members’ lives: Predictable Payments.

No matter the total amount you owe, you will only be billed a maximum of $100 per month until your balance is paid off. This method offers a clear, manageable way to handle medical expenses, allowing you to focus on what truly matters—your health.

You can read more about predictable payments here.

How can I get an estimate for lab work?

Tia does not have its own lab to run lab work or diagnostic analysis. Tia partners with independent labs like Quest Diagnostics instead of larger hospital systems as a way to keep costs lower for patients. Like any provider, Tia will always suggest confirming with your insurance provider if you are in-network with Quest and if your lab services are covered by your plan. You can contact Quest Diagnostics at (888) 445-5011 or email PatientNavigators@QuestDiagnostics.com for cost estimates, billing questions, and more information. If you’d prefer to use a different lab for your lab work, you can request this with your provider to create a lab order.

How will I be billed if I have multiple appointments in one day?

Tia will bill for each service provided. Some health insurance plans do not allow for multiple visits per day with the same provider. In the event you receive multiple services from Tia under more than one visit in a day, you may be responsible for the full cost of any additional visits after your first visit.