How Can We Help You?
Thank you for choosing Springfield Clinic for your health care needs. We appreciate the opportunity to deliver your medical care and hope the entire experience has exceeded your expectations. We understand that you may have questions about billing, insurance benefits, and payments. We offer several ways to contact our team for assistance.
In addition to our Monday through Friday telephone and in-person representatives, we now offer the ability to submit your questions online any time.
We are happy to assist you usually within one business day of receiving your online question. Please complete the fields in the online form and let us know the best method for contacting you with the resolution.
Customer Service Representatives at 217.528.7541 or toll-free at 800.844.7541, Monday through Friday, 8:00 a.m. – 5:00 p.m.
Medical interpreters are available to help patients communicate with Clinic staff. For more information, please contact Interpreter Services at 800.444.7541.
If you would prefer to speak with someone face-to-face, we invite you to visit our Customer Service Representatives Monday through Friday, 8:00 a.m. - 5:00 p.m. (except holidays) located at following locations:
Springfield Clinic Main Campus East (1st Floor)
Springfield Clinic Main Campus West (1st Floor)
Springfield Clinic 1st - 800 Building (1st Floor)
Springfield Clinic Taylorville (1st Floor)
Springfield Clinic Wabash (1st Floor)
If you have insurance or other account information changes that you would like to inform us about, you can contact us by telephone at 217.528.7541 or 800.444.7541 Monday through Friday 8:00 a.m. – 5:00 p.m.
*Please note, a signature is required on all forms before submission.
Authorization for Release of Medical Information - The authorization for release of information is needed for hard copy medical records.
Notice for Revocation Authorization Form - Filled out when a patient chooses to revoke a previously completed authorization.
Statement of Extended Family Billing Agreement - Form to be completed when the patient, who is no longer a minor, chooses to remain on their parent's account.
Authorization & Assignment - This form authorizes the clinic to disclose medical information in an effort to obtain proper payment from the patient’s insurance carrier and assigns those payment benefits to Springfield Clinic.
Statement of Extended Family Agreement - Filled out by the patient when the patient, who is no longer a minor, chooses to remain on their parents' account.
Your insurance company should send you a form explaining what they paid on charges submitted by your physician. This form is referred to as the Explanation of Benefits, or “EOB” for short. Your Explanation of Benefits will tell you if your charges were applied to your deductible or denied for some reason. They will also tell you how much was paid, how much was adjusted off due to the contractual agreement between your insurer and your provider, and how much is left for you to pay.
Most EOB’s show a breakdown of the charges under several headings which usually read from left to right. The most common headings are:
Date of Service - the date of the appointment or procedure. Services - codes used by the medical provider to tell the insurance company what services were rendered to the patient.
Amount Billed - the amount of charges submitted by the medical provider.
Approved Amount - the amount the insurance company approved for payment. Insurance companies often have pre-determined dollar amounts that they consider “usual and customary” for each medical service code. This pre-determined amount is often different than what your medical provider charges for that service. Depending on the contract or agreement between your insurance company and medical provider, or lack thereof, the difference between the Approved Amount and the billed amount may be adjusted (reduced to $0) or transferred to Patient Responsibility (see below).
Amount Paid - the amount the insurance company paid to the medical provider for the services rendered.
Applied to Deductible - the amount of charges that the insurance company has applied to the deductible. Most insurance plans require the patient to pay for a certain portion of their medical charges each plan year before the insurance coverage begins to pay. This is called the plan deductible and it comprises a portion of the total Patient Responsibility (see below).
Applied to Co-insurance – the amount of charges that the insurance company has applied to the co-insurance element of the plan. Some insurance plans require the patient to pay for a percentage of the charges for each medical service. This is called co-insurance and it comprises a portion of the total Patient Responsibility (see below).
Patient Responsibility - the amount you owe. This is made up of the deductible, co-insurance and any charges not covered by the insurance plan.
Denial Codes - Sometimes the insurance company will deny (refuse to pay) a charge for some reason. In this case, the EOB will contain alpha or numeric codes next to each procedure which indicate the reason for the denial. The explanation of these codes will often be found at the bottom of the page or on the reverse of the EOB. Some denial codes require the patient to contact the insurance carrier in order to resolve questions or other issues that are preventing payment from being made.
Patient Tip:
We recommend that you compare your insurance EOB’s to the bill received from the medical provider. Check to see if the payment was posted correctly and the amount owed on the bill matches the amount indicated on the EOB. Springfield Clinic makes this comparison easier by including detailed charge and payment information on all Clinic statements. Any questions can be directed to our Customer Service Representatives at 217.528.7541 or toll-free at 800.844.7541, Monday through Friday, 8:00 a.m. – 5:00 p.m.
For your convenience, we accept payments in a variety of methods. We accept cash, checks, money orders, credit cards and debit cards. Payment is due in full upon receipt of your billing statement.
AffordaPay™
Springfield Clinic patients with budget payment plans were notified by mail that their budget plan account balance would be transferred to AffordaPay™ for servicing and management. AffordaPay™ is an extended payment program from U.S. Asset Management, a national leader in healthcare financial services. AffordaPay™ provides financial services similar to Springfield Clinic’s budget plan program, including 0% APR and set payment amounts. AffordaPay FAQs
AffordaPay™ is an industry leader in healthcare financial services— not a collection agency or credit card company.
Through AffordaPay™, patients will continue to pay off their account balance interest free with 0% APR in manageable monthly payments.
Payments options include US mail, telephone, auto-pay setup and an online account management portal - www.AffordaPay.com
Contact information:
AffordaPay™
PO Box 981005
Boston, MA 02298-1005
217.210.6682 or 855.484.3143 (toll free)
www.AffordaPay.com
Call center hours (central time zone): Mon-Thurs, 8am-8pm | Fri, 8am-5pm | Sat, 8am-12pm
AffordaPay by U.S. Asset Management Inc. A fully compliant debt purchase solutions provider
Welcome to U.S. Asset Management’s AffordaPay program. AffordaPay allows guarantors more options to pay off balances with interest free monthly payments. Our AffordaPay team looks forward to assist.
The good faith estimate shows the list of expected charges for items or services from your provider or facility. Because the good faith estimate is based on information known at the time your provider or facility creates the estimate, it won’t include any unknown or unexpected costs that may be added during your treatment. Generally, the good faith estimate must include expected charges for:
The primary item or service
Any other items or services you’re reasonably expected to get as part of the primary item or service for that period of care.
The estimate might not include every item or service you get from another provider or facility, even if some items or services may seem connected to the same service. For example, if you’re getting surgery, the good faith estimate could include the cost of the surgery, anesthesia, any lab services, or tests. In some cases, items or services related to the surgery that are scheduled separately, like certain pre-surgery appointments or physical therapy in the weeks after the surgery, might not be included in the good faith estimate. You’ll get a separate good faith estimate when you schedule those items or services with the provider or facility, or if you ask for it.
Providers and facilities must give you the good faith estimate:
After you schedule a health care item or service. If you schedule an item or service at least 3 business days before the date you’ll get the item or service, the provider must give you a good faith estimate no later than 1 business day after scheduling. If you schedule the item or service OR ask for cost information about it at least 10 business days before the date you get the item or service, the provider or facility must give you a good faith estimate no later than 3 business days after you schedule or ask for the estimate.
That includes a list of each item or service (with the provider or facility), and specific details, like the health care service code.
In a way that’s accessible to you, like in large print, Braille, audio files, or other forms of communication.
Providers and facilities must also explain the good faith estimate to you over the phone or in person if you ask, then follow up with a written (paper or electronic) estimate, per your preferred form of communication.
To learn more and get a form to start the process, go to www.cms.gov/nosurprises/consumers or call 1-800-985-3059. For questions or more information about your right to a Good Faith Estimate or the dispute process, visit www.cms.gov/nosurprises/consumers or call 1-800-985-3059.
*Source: Centers for Medicare & Medicaid Services ( https://www.cms.gov/nosurprises/consumers)
