Patient Rights · Billing
Billing & Patient Rights
A medical bill should never be a mystery. This page explains what to expect from a SEVA Healthcare bill, the rights federal and state law give you, and exactly who to call when something does not look right.
The basics
Understanding your medical bill
Interventional pain care often involves more than one charge. A single visit can include the office visit itself, an image-guided procedure, medications and supplies used during that procedure, and sometimes anesthesia support. If your procedure takes place at a surgical facility rather than in one of our clinics, you may also receive a separate bill from that facility or from another provider involved in your care.
If you have insurance, your plan is billed first. Your plan then decides what it will pay and what it will leave to you as a copayment, coinsurance, or deductible. The document your plan sends you is called an Explanation of Benefits. It is not a bill — it is your plan's account of how it processed the claim. Comparing your Explanation of Benefits against the bill you receive is the single most useful thing you can do before you pay.
You can always ask for an itemized bill
If a bill is hard to follow, ask us for an itemized version that lists each charge separately. Ask us to explain anything on it that is not clear. We would much rather answer questions before a bill goes unpaid.
Before your care
Your right to a Good Faith Estimate
If you do not have health insurance, or you have insurance but choose not to use it for a particular service, federal law gives you the right to a written estimate of your expected charges before you receive scheduled care. This is called a Good Faith Estimate.
If your final bill from the same provider or facility ends up substantially higher than the estimate you were given, federal rules may allow you to dispute the charges. We would rather sort out a difference directly with you first, so please contact us before starting any dispute process.
Insured patients can ask for an estimate too. The federal Good Faith Estimate rules are written for uninsured and self-pay patients, but our billing team is glad to give any patient an estimate of expected costs.
Full details, including who qualifies, what the estimate covers, and how to request one: Good Faith Estimate — know what your care will cost.
Surprise bills
Protection from surprise billing
A "surprise bill" is an unexpected bill from a provider who is not in your health plan's network, in a situation you could not really control. The clearest example is an emergency. Another is scheduling care at a facility that is in your network and then being treated there by a provider who is not.
Under the federal No Surprises Act, when these protections apply you cannot be billed more than the copayment, coinsurance, and deductible you would owe for in-network care. Your health plan pays the rest directly to the out-of-network provider or facility. Amounts you pay in these situations also count toward your in-network deductible and out-of-pocket limit.
Whether a specific bill is covered by these protections depends on the type of coverage you have, where you were treated, and which service you received. State law may add further protection on top of the federal rules. If you think a bill you received should have been covered by these protections, contact us and we will review it with you.
Two situations worth knowing
Emergency services and out-of-network care
Emergency services
If you have an emergency medical condition and you are treated by a provider or facility outside your plan's network, federal law generally limits what you can be billed to your plan's in-network cost sharing. Your plan generally must cover emergency services without requiring prior authorization first, and without treating out-of-network emergency care more restrictively than in-network emergency care. These protections can also extend to care you receive after you are stabilized, unless you give written consent to give them up.
In a medical emergency, call 911 or go to the nearest emergency room. Do not delay emergency care to check whether a provider is in your network. SEVA Healthcare clinics do not provide emergency care.
Out-of-network care
"Out-of-network" simply means a provider or facility has not signed a contract with your health plan. Being out-of-network usually means higher costs for you, and in some situations an out-of-network provider may bill you for the difference between what your plan pays and what was charged. That practice is called balance billing, and federal law restricts it in the situations described above.
You are never required to give up your protections against balance billing, and you are never required to receive out-of-network care. You can ask for a provider or facility in your plan's network. Whether any particular SEVA provider participates in your plan depends on your specific plan, so please check with us and with your plan before your appointment.
Insurance
Insurance and patient responsibility
Your health plan — not SEVA Healthcare — decides what your coverage includes. Your plan sets your deductible, copayment and coinsurance amounts, your out-of-pocket maximum, which services need prior authorization, which providers are in its network, and whether a particular service is a covered benefit for you. We cannot change those terms and we cannot promise that a service will be covered or that a claim will be paid.
What we can do is check before you are treated. Our billing team will verify your benefits at no charge so that you know what to expect, and we will tell you if a service is likely to need prior authorization.
Bring these to your appointment
Your current insurance card, a photo ID, and any referral or authorization paperwork your plan has sent you. If your coverage has changed since your last visit, tell us — claims sent to a plan you have left are a common cause of unexpected bills.
For the plan types we work with and how benefit verification works: Insurance coverage at SEVA Healthcare.
Paying for care
If you are uninsured or paying for care yourself
SEVA Healthcare offers discounted self-pay pricing for uninsured patients. Ask for our cash-pay rate when you schedule, and ask for a Good Faith Estimate in writing at the same time.
We also accept a number of other ways of paying for care:
- Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA)
- CareCredit and Cherry payment plans
- In-office installment plans
- Health sharing ministries, including Medi-Share, Samaritan Ministries, and Sedera
Which option makes sense depends on your situation and on the care you need, so please ask our team. Availability and terms for third-party payment plans are set by those companies, not by SEVA Healthcare.
Getting it sorted
Questions about your bill, and how to dispute one
Most billing problems turn out to be fixable — a claim sent to the wrong plan, a missing authorization, an out-of-date insurance card, or a charge that simply needs explaining. Start with us.
- 1
Call or email our billing team
Use the phone number for the state where you received care, or email us. Have your bill and your Explanation of Benefits with you if you can.
- 2
Ask for an itemized bill and an explanation
We will walk through the charges with you, check how the claim was submitted, and correct anything that was billed in error.
- 3
Contact your health plan if the question is about coverage
If the issue is how much your plan paid or whether a service was covered, your plan's member services line is the right place. Your plan also has an appeals process, described in your plan documents.
- 4
Contact a government agency if you still believe a bill is wrong
You do not need our permission, and you do not need to wait for us. The agencies below are listed for you to use.
Government resources
Where to get independent help
These are official federal and state resources. Use the state agency for the state where you received your care.
Federal
No Surprises Help Desk
Answers questions about federal surprise billing and Good Faith Estimate protections, and takes complaints about providers, facilities, and insurers. Help is available in English, Spanish, and more than 350 other languages.
1-800-985-3059 · CMS medical bill rights website · Submit a complaint to the No Surprises Help Desk
Texas
Texas Department of Insurance
Handles questions and complaints about health plans regulated by the State of Texas, including Texas balance billing protections. You can usually tell whether Texas law applies by looking for "TDI" or "DOI" on your insurance card.
Oklahoma
Oklahoma Insurance Department
Oklahoma has not enacted its own surprise billing law, and the Oklahoma Insurance Department states that enforcement of the federal No Surprises Act for Oklahoma consumers is carried out by the Centers for Medicare & Medicaid Services. The department's Consumer Assistance Division can still help with insurance questions.
New Mexico
New Mexico Office of Superintendent of Insurance
Enforces the New Mexico Surprise Billing Protection Act, which limits what you owe for a surprise bill to your in-network cost sharing. The office also explains that a provider cannot send a surprise bill to a collection agency, and that you may be owed a refund if you paid more than you should have.
1-855-427-5674 · New Mexico Office of Superintendent of Insurance website
Contact us
Talk to our billing team
Use the number for the state where you received care, or email us. Please include your name and date of service so we can find your account.
- Phone — Texas
- (214) 306-4116
Lewisville & Rowlett - Phone — Oklahoma
- (918) 935-3240
Tulsa Midtown & Tulsa South - Phone — New Mexico
- (505) 431-2501
Santa Fe - info@sevamedcare.com
Put "Billing question" in the subject line
For clinic addresses and hours, see Contact SEVA Healthcare. If you need help using this website, see our Accessibility Statement.
Answers
Frequently asked questions
Why did I get more than one bill for one appointment?
Different parts of your care can be billed separately. If your procedure was done at a surgical facility rather than in one of our clinics, that facility and other providers involved in your care may bill you separately from SEVA Healthcare. Call us and we will help you work out which bill is which.
Is an Explanation of Benefits a bill?
No. An Explanation of Benefits comes from your health plan and describes how it processed a claim — what was charged, what the plan paid, and what it says you owe. Your bill comes from the provider. Compare the two before you pay.
Can you tell me what my care will cost before I have it?
Yes. If you are uninsured or paying yourself, you have a federal right to a written Good Faith Estimate, and you can read how to request one on our Good Faith Estimate page. If you have insurance, our billing team can verify your benefits and give you an estimate of your expected costs.
Will my insurance cover my procedure?
That is your health plan's decision, and it depends on your specific plan and on medical necessity criteria your plan applies. We cannot promise coverage. We can verify your benefits before your appointment and tell you whether prior authorization is likely to be needed.
What if I cannot pay my bill all at once?
Talk to us rather than leaving the bill unpaid. We accept HSA and FSA funds, CareCredit and Cherry payment plans, in-office installment plans, and several health sharing ministries. Terms for third-party plans are set by those companies.
Do I have to go through SEVA before contacting a government agency?
No. You can contact the federal No Surprises Help Desk or your state insurance agency at any time. We ask you to start with us only because most billing problems are quicker to fix directly.
About this page
This page is general information for patients about medical billing and about rights created by federal and state law. It is not legal advice, and it is not a statement of what your health plan will cover. Whether a particular protection applies to a particular bill depends on your coverage, where you were treated, and the service you received. Laws and regulations change over time. For questions about your own bill, please contact our billing team using the details above.
Last reviewed: · Accessibility concerns: info@sevamedcare.com
