Billing & Insurance FAQs

While we make every effort to ensure accurate billing, if you have questions, please call and speak to one of our billing and insurance specialists or check out our frequently asked questions.

Madison Women’s Clinic is contracted with both the CCN and IPN networks. These networks include many of the employers in our area. We are also contracted with other insurance companies which are frequently used in our area, such as Blue Cross, Blue Shield, Deseret Mutual, and Idaho Medicaid. We are happy to bill your Medicare and TriCare/TriWest claims for you, and will accept assignment on those claims.
GYN patients will be asked for their co-payments at the time of their visit. If you have no insurance, we request that you pay your bill at the time of service
OB patients will be given a financial form which explains estimated costs and payment options. We appreciate your willingness to set up a workable financial arrangement for both of us.
Surgical patients will also be given an estimated cost sheet with projected insurance coverage.
At our clinic, we strive to be accessible and approachable in meeting your billing needs. We will submit your insurance claims; and, if you encounter a problem with your bill or insurance claim, please call us and we will try to satisfactorily answer your question. Please feel free to call us at 208-356-6185.

Frequently Asked Questions

What is this bill from LabCorp?

When you have a pap smear or biopsy done in our clinic, we send the specimen to a pathologist for reading, and the bill that comes from LabCorp is the pathologist’s bill. We do not charge in our office for the pap smear to be done. If your pap smear needs further evaluation, LabCorp will charge an additional fee.

Why is LabCorp billing me for my prenatal laboratory work?

If you are applying for Idaho Medicaid for your pregnancy, and you don’t yet have a Medicaid number when you come to our office for your first visit, LabCorp will bill you (the patient) directly until you have provided them with your Medicaid number. When you receive that bill from LabCorp, just call their customer service line at 1-800-845-6167 and give them your Medicaid number. If you have problems in that regard, feel free to call our clinic and we will assist you.

Can you change the diagnosis on my claim and resubmit it?

We are happy to review your chart and make sure that we, indeed, have coded your visit correctly; but if in that review, the medical facts don’t match your request, we can not recode and resubmit. That is considered insurance fraud. If in that review, the medical facts do match your request, we are more than happy to send a corrected billing.

How do I apply for Idaho Medicaid for my Pregnancy?

Just call 208-359-4750, the State Health & Welfare Department. They will tell you how to obtain an application, and will also give you guidelines for qualifying for the PWC program. We also have applications in our office. The State will set up your appointment once they receive your application.

I am on DMBA student insurance and am pregnant. How do I get an authorization number for my pregnancy?

Call DMBA (1-800-777-3622). They will provide a six-digit authorization number which will activate your insurance for your entire pregnancy. Please bring that number to your visit, so we have it on file.

I just received my Medicaid card in the mail. What do I do with it now?

DON’T LOSE IT! Bring it to your next appointment (if you have one), and we’ll copy it for our records. If you don’t have a future appointment, call our clinic and give us the ten-digit MID number. You’ll also need to call LabCorp (1-800-845-6167) if you’ve received a bill from them, and provide them with that number. You’ll also need to take the card with you to the hospital at the time of delivery.

My insurance company says that my exam and surgery are covered. Why do I still owe money to Madison Women’s Clinic?

The short answer is that “covered” doesn’t mean paid for, it only means that the medical services provided are services that your insurance plan includes in your agreement. There are a number of additional considerations before determining who will pay for what services. Here are those considerations:

1. Deductible – Before an insurance company will pay a claim, they may require an annual deductible must be met by the insured. If your deductible is $500, you as the insured patient will be responsible for the first $500 of healthcare costs that are “covered” in your insurance plan. Deductibles are nearly universal with insurance plans and you need to know yours when getting signed up with insurance.

2. In-Network vs. Out-of-Network – Once the question is answered regarding your deductible, the insurance company considers whether it has an “in-network” contract with the medical provider who provided services. If there is a contract with the provider, the in-network payment model applies and the insurance company usually pays a higher percentage of the total cost. When the medical provider is not in-network, out-of-network pricing applies, which is almost always a higher responsibility for the insured patient. For example, using an in-network provider could result in the patient paying 0-30% of the cost after deductible, while the same services by an out-of-network provider would likely result in the patient bearing 50-100% of the total cost after deductible. For this reason, it is worth taking the time to learn which of your doctors are in-network and likely to be the lowest cost options.

3. Co-payments – Separate from the deductible is a patient responsibility for co-payments. Co-payments are the fees that you pay for an exam at the time of service, such as a $20 fee for a office visit to your eye doctor when doing an annual exam. These fees do not count towards your deductible with most insurance plans.

4. Co-Insurance – After an insured patient has met their annual deductible and the network question is answered, costs for covered services are split between the insurance company and the patient at the plan rate, such as an 80/20 split for a medical provider who is in-network. With this as an example, the patient would be responsible for 20% of the cost for covered services AFTER the deductible has been met and the insurance company would pay for 80% of the cost of covered services AFTER the deductible was accounted for.

5. Out-of-Pocket Maximum – The last piece that is a major part of any insurance plan is the out-of-pocket maximum, which it the most you will pay for covered services in a plan year. This number represents the MOST you will pay for your deductible and co-insurance. After you reach your out-of-pocket maximum, your health insurance carrier will pay 100% of of the cost for covered benefits for the rest of your plan year.

6. Non-covered Services– This is a service that is not included in a person’s insurance. A common example within the medical field is aesthetic procedures, usually this wouldn’t be covered since it an optional procedure. It is important to note that services that are not covered by insurance are paid 100% by the patient. It is vital to know what is covered in your own plan so you can properly prepare to pay for it.