You may receive a bill after your insurance carrier processes the claim and assigns part of the cost to you.

A patient balance may result from:

• Deductible
• Copayment
• Coinsurance
• Non-covered services
• Insurance limitations or exclusions
• Coordination of Benefits issues
• Missing or outdated insurance information
• Claim denials or other payer processing decisions

TE-Billing Solutions® does not determine your insurance benefits or patient responsibility. These amounts are based on how your insurance carrier processes the claim and the terms of your insurance plan.

If you believe the balance is incorrect, TE-Billing Solutions® can review the billing activity and help determine whether additional research or correction is needed.

After your insurance processes a claim, you may still be responsible for part of the cost based on the terms of your insurance plan.

Your balance may include amounts applied to:

• Deductible
• Copayment
• Coinsurance
• Non-covered services
• Services that exceeded plan limitations
• Other patient-responsibility amounts determined by your insurance carrier

TE-Billing Solutions® does not determine your insurance benefits or patient responsibility. These amounts are based on how your insurance carrier processes the claim.

If you have questions about why a specific amount was assigned to you, please review your Explanation of Benefits or contact your insurance carrier directly.

Insurance claims must first be processed by your insurance carrier before a patient balance can be determined.

Delays may occur due to insurance processing timelines, coordination of benefits, updated insurance information, or documentation requests.

A statement is generated only after insurance has completed its review and any remaining balance is assigned according to your plan benefits.

If your contact information or insurance coverage changed after your visit, please notify us to ensure accurate account processing.

A bill may be issued for an older date of service if insurance processing or account resolution took additional time.

Common reasons include:

• Insurance claim delays
• Claim denials or reprocessing
• Coordination of Benefits issues
• Secondary insurance processing
• Corrected claims
• Requests for additional information
• Insurance eligibility updates
• Payer appeals or follow-up

The balance may not become patient responsibility until the insurance process is completed or additional information is received.

An Explanation of Benefits, or EOB, is provided by your insurance carrier and explains how a claim was processed. An EOB is not necessarily a bill.

Your provider’s statement reflects the balance remaining on your account after insurance payments, adjustments, claim corrections, or other account activity have been applied.

Differences may occur if:

• Insurance reprocessed the claim
• Additional payments or adjustments were posted
• A corrected claim was submitted
• Secondary insurance is still pending
• The EOB was issued before the provider’s account was updated

If you believe your statement does not match your most recent EOB, TE-Billing Solutions® can review the billing activity and help determine whether additional research is needed.

A deductible is the amount you may be required to pay for covered healthcare services before your insurance plan begins paying according to your benefits.

A copayment is generally a fixed amount you pay for certain covered services.

Coinsurance is generally a percentage of the allowed amount that you may be responsible for after applicable deductible requirements are met.

The exact amounts and rules depend on your individual insurance plan.

TE-Billing Solutions® does not establish deductibles, copayments, or coinsurance amounts. Please contact your insurance carrier for specific benefit information.

Insurance eligibility may be verified as a courtesy based on the information available at the time of service. However, eligibility verification is not a guarantee of coverage or payment.

Benefit information is provided by insurance carriers and is subject to the terms, limitations, exclusions, deductibles, copayments, coinsurance, authorization requirements, and other provisions of the patient’s individual insurance plan.

Patients should contact their insurance carrier directly for definitive information regarding coverage and benefits.

TE-Billing Solutions® can help explain billing-related information shown on claims, statements, and Explanation of Benefits documents.

However, we do not determine insurance coverage, benefits, medical necessity, or whether a specific service will be paid by your insurance plan.

Coverage and benefit decisions are made by your insurance carrier and are subject to the terms, limitations, exclusions, deductibles, copayments, coinsurance, authorization requirements, and other provisions of your individual insurance plan.

For definitive information about your coverage or benefits, please contact your insurance carrier directly.

If your insurance coverage has changed, please provide the updated information as soon as possible through an approved secure patient billing channel or directly to your healthcare provider.

Updated information may include:

• Insurance carrier name
• Member identification number
• Group number
• Policyholder information
• Effective date of coverage
• Primary and secondary insurance information

Delays in providing updated insurance information may result in claim delays, denials, or patient balances if payer filing deadlines have passed.

Do not send insurance identification information through general website chat or other unsecured communication channels.

If you have more than one insurance plan, the insurance carriers determine which plan is primary and which is secondary through Coordination of Benefits.

The primary insurance generally processes the claim first. The remaining eligible balance may then be submitted to the secondary insurance.

TE-Billing Solutions® does not determine which plan is primary or secondary.

If your insurance carriers have incorrect Coordination of Benefits information, claims may be delayed or denied until you contact the carriers and update your records.

If you have more than one insurance plan, your insurance carriers determine which plan is primary and which is secondary.

Claims must be processed by the primary insurance first. Any remaining eligible balance may then be submitted to the secondary insurance according to the terms of your plans.

If an insurance carrier indicates that another policy exists, claims may be delayed or denied until Coordination of Benefits is updated directly with the insurance company.

TE-Billing Solutions® does not determine which insurance plan is primary or secondary. That determination is made by the insurance carriers.

If you recently changed insurance coverage or believe your Coordination of Benefits information is incorrect, please contact your insurance carrier directly to update it.

Some HMO and managed care plans require a referral or prior authorization before certain services are covered.

If a required referral or authorization was not obtained before the visit, your insurance carrier may deny the claim or assign some or all of the balance to you.

Referral and authorization requirements are determined by your specific insurance plan and are not controlled by TE-Billing Solutions®.

If you are unsure whether your plan requires a referral or prior authorization, please contact your insurance carrier directly.

If you are enrolled in a Medicare Advantage plan, your services are processed through your Medicare Advantage carrier — not traditional Medicare.

In most cases, only your Medicare Advantage plan information is required for claim submission.

Original Medicare cards are used when a patient is enrolled in traditional Medicare without an Advantage plan.

If you are unsure which type of Medicare plan you have, your insurance carrier can confirm your enrollment and coverage details.

Eye-care visits are billed based on the reason for the visit and the provider’s documented clinical findings — not simply the type of provider seen.

If medical symptoms, diagnosis, treatment, or monitoring of an eye condition were addressed during your visit, the claim must be processed through medical insurance in accordance with insurance billing guidelines.

Routine vision plans typically apply when no medical concerns are evaluated.

Billing classification is determined by documentation requirements and insurance regulations. It is not based on preference or benefit availability.

If you have questions about how your deductible, copay, or coinsurance was applied, your insurance carrier can review your specific plan details.

TE-Billing Solutions® cannot independently change a diagnosis, procedure code, or clinical documentation.

Coding is based on the healthcare provider’s medical record and the services documented by the provider.

If you believe a service was coded incorrectly, please contact your healthcare provider. TE-Billing Solutions® may assist with billing-related research or claim corrections when authorized by the provider.

Insurance carriers determine coverage and payment based on your specific plan benefits, eligibility status, and policy guidelines at the time of service.

If your insurance applies the balance to your deductible, coinsurance, or denies coverage, the remaining balance becomes the patient’s responsibility according to your plan.

Common reasons for claim adjustments or denials include:

• Deductible not yet met
• Non-covered services under your plan
• Coordination of benefits issues
• Inactive or incorrect insurance information
• Referral or authorization requirements

If you believe your insurance processed the claim incorrectly, your insurance carrier can review the claim details and explain how the determination was made.

If your insurance carrier states that a claim was not received, TE-Billing Solutions® may review the billing record to determine whether the claim was submitted and whether additional follow-up is appropriate.

Depending on the circumstances, we may review:

• Claim submission history
• Clearinghouse information
• Payer responses
• Claim status
• Timely filing requirements

If appropriate and authorized, the claim may be resubmitted or corrected.

Resubmission does not guarantee that the insurance carrier will pay the claim.

Insurance carriers may sometimes delay or deny a claim because they need information directly from the patient.

Examples may include:

• Coordination of Benefits information
• Accident or injury details
• Other insurance information
• Coverage verification
• Policyholder information
• Responses to insurance questionnaires

TE-Billing Solutions® cannot provide personal information to the insurance carrier on your behalf when the carrier requires a response directly from you.

If your insurance carrier requests information, contact them as soon as possible. Once the requested information is provided, the carrier may be able to continue processing the claim.

If a claim is denied due to missing or incorrect insurance information and is still within the insurance carrier’s timely filing limits, it may be eligible for resubmission once updated information is received.

If a claim is denied due to plan design, coverage limitations, benefit exclusions, or authorization requirements, it cannot be altered by the billing department.

Timely filing requirements are determined by your insurance carrier and cannot be extended by the provider or billing office.

If you have updated insurance information, please contact us as soon as possible so we can review eligibility for resubmission.

Claim-processing times vary by insurance carrier, insurance plan, claim type, and whether additional information is required.

Some claims process quickly, while others may take longer because of:

• Eligibility review
• Coordination of Benefits
• Medical record requests
• Referral or authorization requirements
• Claim corrections
• Payer review
• Additional information requested by the insurance carrier

TE-Billing Solutions® monitors and follows up on claims as part of authorized billing services, but we do not control an insurance carrier’s processing timeline.

If you believe there may be incorrect insurance information, a missing payment, or another administrative account concern, please contact us so we can review the details.

Billing is processed based on the provider’s documented clinical findings and insurance carrier guidelines.

Disagreements regarding insurance coverage, benefit structure, or plan limitations must be addressed directly with your insurance carrier.

If updated insurance information is available, please provide it as soon as possible so eligibility for resubmission can be reviewed within timely filing limits.

If you believe there is an error on your billing statement, TE-Billing Solutions® may review billing-related information to help identify possible posting, insurance, or claim-processing issues.

Questions involving:

• The services that were performed
• Medical necessity
• Clinical documentation
• Diagnosis
• Treatment
• The provider’s original charge for a service

may need to be directed to the healthcare provider.

TE-Billing Solutions® cannot independently change clinical documentation or provider-established charges.

If you believe you already paid the balance shown on your statement, please allow time for your payment to be received and posted to your account.

If the payment has already cleared and the balance still appears, TE-Billing Solutions® may review the account and payment history.

You may be asked to provide information such as:

• Payment date
• Payment amount
• Payment method
• Confirmation or transaction information

Do not submit full payment-card numbers through general website forms, chat, or standard email.

TE-Billing Solutions® does not independently waive, reduce, or remove patient balances.

Patient balances are based on the healthcare provider’s charges, insurance processing, contractual adjustments, payments, and other authorized account activity.

Any adjustment, discount, payment arrangement, or balance reduction must be authorized by the applicable healthcare provider or handled according to the provider’s established policies.

If you believe your balance is incorrect, TE-Billing Solutions® can review the billing information and help determine whether additional research or correction is needed.

Payment-plan availability is determined by the healthcare provider and may vary by practice.

TE-Billing Solutions® may assist with payment-related questions or help direct you to the appropriate payment option when authorized by the provider.

A payment arrangement is not considered approved unless it has been authorized according to the healthcare provider’s policies.

Please contact the billing team or your provider’s office to ask whether payment arrangements are available for your account.

If you believe your account has been overpaid, TE-Billing Solutions® may review the account balance, insurance payments, patient payments, and applicable adjustments.

A credit balance does not automatically mean a refund is immediately due. Additional claim activity, insurance reprocessing, secondary insurance, or other account activity may need to be reviewed first.

Refunds are issued according to the healthcare provider’s policies and applicable requirements.

TE-Billing Solutions® may assist with identifying and researching potential credit balances but does not independently authorize refunds unless permitted by the healthcare provider.

Secure payment links and text-to-pay options may be provided on behalf of your provider’s office.

Payments are processed through the payment platform authorized by the applicable healthcare provider. You may also check your healthcare provider’s website for available payment options.

TE-Billing Solutions® does not store full payment-card numbers through its website.

If you prefer to make a payment by phone, a team member may assist you through the provider’s authorized payment system.

Our team carefully reviews each inquiry to ensure accuracy.

If additional research, insurance follow-up, or account updates are required, a member of our team may contact you directly.

Not all inquiries require a return phone call. Many questions can be resolved during the initial interaction or through account review.

Submitting duplicate inquiries may delay resolution. If your question involves medical care, treatment, or clinical concerns, please contact your healthcare provider directly.

TE-Billing Solutions® provides billing and revenue cycle support and does not provide medical treatment, clinical advice, or medical-record services on behalf of patients.

For questions regarding:

• Medical records
• Test results
• Diagnoses
• Treatment
• Prescriptions
• Symptoms
• Clinical documentation
• Medical advice

please contact your healthcare provider directly.

For billing, insurance, claim, payment, or account-balance questions, TE-Billing Solutions® may assist when authorized by your provider.

TE-Billing Solutions® specializes exclusively in medical and vision billing support for optometry and ophthalmology practices.

We do not provide clinical services, medical diagnosis, or medical advice.

For questions regarding symptoms, treatment, medical findings, or clinical documentation, please contact your provider directly.