Commercial Concierge Team

The Commercial Care Concierge Team is designed to assist patients with commercial health insurance, including many employer-sponsored and individual health plans. Insurance benefits and requirements vary, so our team will work with you to understand what applies to your specific plan.

Depending on your insurance plan and the service you are receiving, our team may be able to help with:• Understanding your insurance requirements
• Coordinating prior authorization
• Reviewing your benefits related to a planned service
• Providing an estimate of your expected out-of-pocket costs
• Answering questions about your insurance coverage
• Helping you understand your financial responsibility before your appointment or procedure
• Connecting you with the appropriate Ozarks Healthcare team member if you have additional billing or financial questions

A prior authorization is approval from your insurance company that may be required before certain medical services, procedures, medications or tests are covered. If your insurance requires prior authorization, our team can help coordinate the process and communicate with your insurance company as appropriate.

*Important: Insurance companies—not Ozarks Healthcare—make the final determination about whether a service requires authorization and whether it will be covered.*

In many cases, Ozarks Healthcare will work with your insurance company to obtain required prior authorization for services. However, requirements vary by insurance plan and type of service. If there is something you need to do as the patient, our team can help explain what is needed and when.

Our team will review your insurance information and the requirements associated with your planned service. If authorization is required, we can help guide you through the process. You can also contact your insurance company using the member services number on the back of your insurance card.

Our team can provide an estimate of your expected out-of-pocket responsibility based on the information available from your insurance plan and the planned service. Because insurance benefits, deductibles and claims processing can change, an estimate is not always the same as the final amount you may owe.

An out-of-pocket cost estimate is an estimate of what you may be responsible for paying after your insurance benefits are applied. Depending on your plan, this may include amounts such as:
• Deductible
• Copayment
• Coinsurance
• Services that are not covered by your insurance

Your estimate will depend on your specific insurance benefits and the services being provided.

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

For example, if you have a $2,000 deductible and have not met any of it yet, you may be responsible for some or all of the allowed cost of a covered service until your deductible is met.

Coinsurance is the percentage of the allowed amount for a covered service that you are responsible for paying after your deductible has been met, depending on your insurance plan.

A copayment, or copay, is a set amount you pay for a covered healthcare service. Your copay may vary depending on the type of service and your insurance plan.

EOB stands for Explanation of Benefits. It is a document from your insurance company explaining how a healthcare claim was processed.

An EOB may show:
• The services that were billed to your insurance
• The amount your provider charged
• The amount your insurance company allowed
• What your insurance plan paid
• Amounts applied to your deductible
• Your copayment or coinsurance
• The amount your insurance company says you may owe

No. An EOB is not a bill. Your insurance company sends you an EOB to explain how your claim was processed. If you owe Ozarks Healthcare money, you will receive a separate statement or bill from Ozarks Healthcare. It is helpful to compare your Ozarks Healthcare statement with your EOB so you can see how your insurance processed the claim.

This can happen because an EOB and a healthcare bill serve different purposes. Your EOB explains how your insurance processed the claim, while your Ozarks Healthcare statement reflects the amount currently being billed to you. The amounts may differ because of insurance adjustments, payments, deductibles, coinsurance, copayments or other factors.

If you have questions about a statement you received from Ozarks Healthcare, our Patient Financial Services team can help.

Not necessarily. An EOB shows how your insurance processed a claim and may list a patient responsibility amount. Your actual bill from Ozarks Healthcare is the best place to confirm the amount currently due to the hospital. If the amounts don't appear to match or you have questions, contact Patient Financial Services before making a payment.

Yes. We make every effort to provide a helpful and accurate estimate based on the information available at the time. However, the final amount may change based on factors such as:
• Changes to your insurance benefits
• How your insurance processes the claim
• Additional services needed during your care
• Services provided by other healthcare professionals
• Changes in your deductible or out-of-pocket status

Understanding your insurance requirements and expected financial responsibility ahead of time can help you plan for your care and avoid surprises. Our goal is to make the insurance and financial side of your healthcare experience as straightforward as possible.

Yes. Our team can help explain information related to your planned Ozarks Healthcare service and the insurance information available to us. Because your insurance company determines your benefits, you may also need to contact your insurer for questions about your overall plan or coverage.

If a planned service is denied, our team can help explain the information we receive from your insurance company and determine what steps may be available, such as additional documentation, reconsideration or an appeal, depending on your insurance plan and the circumstances.

You're not alone. EOBs can be difficult to understand. Start by reviewing the EOB for the service date, claim information, amount your insurance paid and amount listed as your responsibility. If you still have questions about how your insurance processed the claim, your insurance company's member services team can help explain the EOB. If your question is about an Ozarks Healthcare bill or statement, our Patient Financial Services team can assist.

If your question is about a bill or statement from Ozarks Healthcare, contact Patient Financial Services. Our team can help review your account, explain charges and discuss available payment or financial assistance options when applicable.

Visit www.ozarkshealthcare.com/patient-financial-services or call 417-257-6701 to learn more.