Understanding your billing

What is a New Patient designation?

All healthcare insurance, including Medicare, set a distinction for first visits in an office or Urgent Care setting. The new patient charge is typically reimbursed at slightly higher rates than all following visits to the same location, due to the additional work required to set up new accounts and obtaining all the necessary details to make this happen. Established patients are ones that have been seen at the office or Urgent Care in the past three years and the charge for this visit is typically less than the new patient charge.

How does Legacy determine what to charge patients?

Your insurance company negotiates rates on your behalf with providers such as Legacy ER & Urgent Care, and agrees upon rates in which they feel are reflective of the value provided to their members. Factors that determine what rates your insurance carrier agrees to include quality of providers, accessibility, & patient experience.

What is the difference between my Explanation of Benefits (EOB) and my invoice from Legacy?


An EOB is something the insurance company sends that explains what is allowed by their policies and what the associated charges are for what these allowances. It is not a bill, but rather a communication from the insurance company to the patient. It may or may not correspond directly to what the final bill is from Legacy. Best thing to do is to not let the EOB confuse you and wait until LER bills you. Then, if you have any questions or concerns, we can help sort those out for you. 


What is in-network vs out-of-network?

In-network means we have a contract with your insurance company and have agreed on what the rates for any service provided to you will be. Out of network means that we do not have a contract with your insurance company in setting the rates, but as a company policy we have agreed to only bill you what the in-network allowed rates are. In the emergency room, state law dictates that all patients have to be treated as if they are in-network, regardless of the in or out of network status deemed by your insurance company.

How do I get assistance in understanding my EOB or invoice?

See above, but basically if you have any questions or problems with your invoice, we are happy to help you in making sure that it is correct. Sometimes this requires us to file appeals or have you call your insurance company, however these are things we will walk you through while assisting you every step of the way.  Email us your questions and we will get back to you immediately.  

Return to top of page
Return to FAQs main menu