As we strive to provide quality care, we are mindful of insurance and payment issues. We hope the following information will assist patients with the management of their health insurance and out of pocket expenses. The information provided may help you better understand our relationship with your insurance carrier and your insurance responsibility. Click here to view a list of group and individual health plans.
Rutgers New Jersey Medical School (NJMS) Faculty Practice participates with many medical insurance plans. However, it is important to understand that your insurance policy is an agreement between YOU and your INSURANCE CARRIER. We will submit the claim on your behalf; however that is NOT a guarantee of payment of the claim. If your claim is rejected or only partially paid, your insurance company should send you an explanation of benefits (EOB). Ultimately, the fees are your responsibility. If we do not participate with your insurance plan, payment is expected at the time of service. For more details about payments due at the time of service, contact your physician. Click here to find a doctor.
Coordination of Benefits
The practice or arrangement of ensuring that insurance claims are not paid multiple times when a patient or enrollee is covered by two (or more) health plans at the same time. The coordination of benefits process ensures that combined payments from both plans do not exceed 100% of the covered charges. Coordination of benefits determines which plan is primary or secondary.
For example: If both you and your spouse are employed and have insurance coverage through your employers, YOUR policy is your primary coverage. According to insurance regulations, your spouse’s policy provides secondary coverage.
Co-pays, deductibles, co-insurances, and fees for non-covered services are expected at the time of your service.
For more definitions of common health insurance terms visit http://www.bls.gov/ncs/ebs/sp/healthterms.pdf .
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