Why is my appointment charge higher than expected?
Seeing a higher charge than you anticipated can be surprising. If you receive a charge that's higher than what you anticipated, it’s usually due to how your insurance processed the claim. The most common reasons include:
Deductibles: You may not have met your annual deductible yet, meaning you are responsible for the full contracted rate of the visit until that deductible limit is reached.
Copays or coinsurance: The initial quote was an estimate, and your insurance ultimately determined a different copay or coinsurance amount once the claim was finalized.
Coverage limits: Your specific plan may not cover the type of visit or service provided.
What to do next: We highly recommend reviewing the Explanation of Benefits (EOB) sent by your insurance, as it will break down exactly how they processed the charge. If you still have questions after reviewing your EOB, please start a chat on the mobile app or web portal.
Why was my appointment claim denied by insurance?
If your insurance denied the claim for your visit, it means they determined the service was not eligible for coverage under your specific plan. The most common reasons for a denied claim are:
Inactive coverage: Your insurance was not active on the date of your appointment.
Out-of-network: While we accept your insurance, the specific provider you booked with may not be in-network for your plan, and your insurance does not have out-of-network benefits.
Telehealth restrictions: Your insurance may not include coverage for telehealth or virtual visits for the specific appointment type you booked.
Missing information: There may be a discrepancy with the insurance details you entered, or an issue with your coordination of benefits if you have multiple plans.
What to do next: Call the Member Services number on the back of your insurance card to ask exactly why the claim was denied. If any action is required from Circle Medical, please ask for the representative's name and the call reference number, and start a chat with your Care Team.
How can I get an itemized bill or superbill for my appointment?
If you need an itemized bill or superbill for out-of-network insurance reimbursement, FSA/HSA claims, or your personal records, this can be provided after your appointment is completed.
If you need an itemized bill for any past appointments, start a chat and specify which appointment dates you need the document for.
When will I receive the invoice for my appointment?
The timeline for your invoice depends on how you are paying for your visit:
Insurance: If we are billing your insurance, it generally takes 4 to 6 weeks for them to process the claim and determine your final balance.
Self-Pay: If you are paying self-pay rates, your invoice will be generated shortly after your appointment is completed.
Either way, you will receive an email notification the moment your final invoice is ready.
Why am I being asked for a payment method when I have insurance?
Even if you are using insurance, we require a valid payment method on file to schedule your appointment. This card is kept securely on your account to cover any patient responsibilities determined by your insurance, such as copays, coinsurance, or unmet deductibles, after your claim has been fully processed.
Please note that the card on your account will be automatically charged 48 hours after your final invoice is generated. This payment method is also used to cover any potential late cancellation or no-show fees.
Why was my insurance billed higher than my previous appointments?
The amount billed to your insurance can vary depending on the specifics of your appointment that day. For example, initial intake appointments or wellness exams are generally billed higher than standard follow-ups. Additionally, if your visit required more time with your provider, or if you discussed new symptoms that increased the medical complexity of the visit, the billing codes will change to reflect that. We recommend reviewing the Explanation of Benefits (EOB) from your insurance for a detailed breakdown.
If you still have concerns after speaking with your insurance and reviewing your EOB, please start a chat with your Care Team.
What if I have a question about a charge from a lab or pharmacy?
Circle Medical isn’t responsible for determining the balance associated with testing at a lab facility. Circle Medical only bills for the appointment with your provider.
If you receive a bill for lab work (like from Quest Diagnostics or Labcorp) or from a pharmacy for your medication, these are entirely separate entities. You will need to contact that specific lab or pharmacy directly with any billing questions regarding their services.