Healthcare billing can be confusing—even if you have insurance. Terms like deductibles, copays, coinsurance, lab fees, and in-network versus out-of-network can make it hard to understand what you will actually pay. It’s normal to ask, “How much will my visit cost?” and “Why am I being charged this amount?” At Passion Health Primary Care, we believe healthcare should be simple and transparent. Our team takes the time to explain your payment options clearly, so you feel confident, informed, and free from unexpected surprises.
This guide breaks down how self-pay and insurance billing typically work at Passion Health Primary Care, how to avoid surprises, and exactly what to do if something on your bill doesn’t look right. It’s written for real people (not billing experts), and it’s aligned with Passion Health’s own patient resources: Pay Your Bill, Insurances Accepted, Self Pay Rates, and the Billing Concerns forms.
Two main ways patients pay: Insurance vs Self-Pay
Insurance: Using insurance (most common)
When you use insurance, your total cost depends on your plan rules. Passion Health’s team aims to help patients understand coverage and out-of-pocket costs so you can focus on care, not paperwork.
In general, insurance billing involves and acceptance of insurances:
The clinic providing care
The clinic sending a claim to your insurance plan
Your plan processing the claim and deciding what it covers
You receiving an Explanation of Benefits (EOB) (not a bill)
You receiving a patient statement (the bill) for what remains after insurance
Option B: Self-pay (cash pay / uninsured)
If you don’t have insurance—or you prefer not to use it—Passion Health offers a self-pay approach intended to be transparent and accessible for individuals and families across the Dallas–Fort Worth area.
Self-pay is often chosen when:
You’re uninsured
Your plan has a very high deductible and you want predictable pricing
You’re between jobs/plans
You prefer a straightforward out-of-pocket rate for certain visits
Important: Even in self-pay, extra services can change the final cost (examples: lab tests, imaging, procedures, injections, vaccines). Those add-ons may be separate charges depending on what’s done and which outside lab is used.
What insurance “usually covers” at a primary care clinic
Passion Health’s insurance page summarizes what many plans commonly help cover, such as:
Primary care visits (sick visits, follow-ups, chronic care)
Annual physicals / preventive visits (based on plan rules)
Women’s health services
Lab tests & screenings (coverage depends on plan + medical necessity)
Specialist referrals (if required)
Vaccines / immunizations (varies by plan)
This is a helpful starting point—but the key phrase is “depends on your plan.” Two people with the same insurance company can have very different costs if they have different plan types, deductibles, networks, or employer benefits.
The biggest reason bills “surprise” patients: Preventive vs Problem visits
Preventive visit (annual physical)
Many plans cover preventive visits at low cost if the visit stays strictly preventive—meaning:
Routine screening questions
Preventive counseling
Age-appropriate screenings
Wellness planning
Problem-focused care during the same appointment
If you also address a new or ongoing medical problem (examples: uncontrolled blood pressure, anxiety symptoms, asthma flare, abdominal pain, a new rash, joint pain, depression medication changes), the visit may become:
Preventive plus a separately billable problem-oriented evaluation
Or a problem visit that is no longer purely preventive
That can affect patient responsibility (copay/coinsurance/deductible). This preventive vs medical issue distinction is one of the most common sources of confusion in primary care billing.
Tip you can use right away:
When scheduling, ask:
“Is this appointment billed as preventive, problem-focused, or both?”
“If we address additional issues, could there be an additional charge?”
The 6 insurance terms that control what you pay
Here’s the “plain English” version of common insurance cost terms:
Premium – What you pay monthly to have insurance (not paid to the clinic).
Copay – A fixed amount you pay for certain visits (example: $30 for primary care).
Deductible – The amount you must pay out-of-pocket before insurance starts paying for many services.
Coinsurance – A percentage you pay after the deductible (example: you pay 20%, plan pays 80%).
Out-of-pocket maximum – The most you pay in a year for covered in-network services (after which the plan pays more).
In-network vs out-of-network – In-network usually costs less; out-of-network may cost more or be not covered.
Passion Health notes they assist patients across plan types, including employer/group coverage, marketplace plans, HDHP, HSA/FSA compatible plans, and sometimes out-of-network benefits (when available).
Which insurance plans are accepted?
Many Passion Health pages show a list of commonly used insurance types and carriers, including: UnitedHealthcare, Aetna, Blue Cross Blue Shield (BCBS), Cigna, First Health, Humana, Medicare, Medicare Advantage, Molina, plus options for uninsured/self-pay and some managed care organizations.
On the main “Insurances Accepted” resource page, Passion Health also encourages patients to call for verification so the team can guide you to the right location and confirm your coverage.
Why verification matters:
Even when a clinic accepts your insurance company, your specific plan may be:
a different network
a narrow network
tied to a specific employer group
requiring a referral/authorization
in-network at one location but not another (depending on contracting)
So the most reliable step is always: verify your specific plan before your appointment.
What changes your cost (even with the same appointment reason)?
Even within primary care, final cost can vary based on what happens during the visit. Common factors:
A) New patient vs established patient
New patients often require more history review and documentation.
B) Complexity and time
More complex problems, multiple symptoms, medication management, or detailed chronic disease planning may increase the level of service billed.
C) Add-on services
Examples that can create separate charges:
Lab tests (bloodwork, cultures)
Imaging (if ordered)
Procedures (EKG, injections, ear lavage, etc.)
Vaccines
In-office testing (flu/COVID tests, strep tests, urinalysis)
D) Outside lab billing
Many clinics use outside labs. In those cases:
The clinic bills the visit
The lab bills the lab work (often separately)
Your insurance processes each claim separately
This is why you may receive more than one bill for a single day of care.
Self-pay at Passion Health: what “transparent” usually means
The Passion Health self-pay page emphasizes access and predictability—quality care even without insurance, designed to be “transparent” and “affordable” across DFW.
In practice, self-pay often means:
You pay an out-of-pocket rate for the office visit
You can ask for estimates up front
You avoid insurance processing delays
You may choose self-pay for certain services even if you have insurance (especially with high deductibles)
When self-pay can be a smart choice
Self-pay can make sense when:
Your deductible is high and you haven’t met it
You want a clear price for a straightforward visit
You don’t want claims to run through insurance for privacy reasons (depending on situation—ask your clinic what’s possible)
You’re uninsured and need timely care
When insurance might save you more
Using insurance may be better when:
You’ve met most of your deductible
You expect labs/imaging/specialist referrals that your plan covers well
You have chronic conditions requiring frequent follow-ups (and you’re in-network)
Best practice: Ask the clinic team for a simple comparison:
“If I use insurance, what’s the usual patient responsibility for a visit like this?”
“If I self-pay, what’s the expected visit cost—and what add-ons could apply?”
Paying your bill online (and why it’s helpful)
Passion Health provides a Pay Your Bill page with a clear payment button that directs patients to an online checkout.
Why online bill pay helps
Faster resolution (especially if you’re balancing multiple statements)
Easier tracking for self-pay patients
Convenient for families managing care across multiple locations
If you’re paying online, keep:
Your statement number (if listed)
Date of service
Patient name and DOB (as requested)
Any notes if you’re making a partial payment
The most important document: your EOB (Explanation of Benefits)
If you used insurance, your EOB is not a bill. It’s your insurance plan’s explanation of what happened when they processed the claim.
Your EOB typically shows:
The billed amount
Allowed/contracted amount (what the plan recognizes)
What insurance paid
What you may owe (patient responsibility)
Denial reasons (if any)
Codes used (procedure + diagnosis)
What to check on the EOB
Use this quick checklist:
If something looks wrong, don’t panic—most billing issues are fixable once the right documents are reviewed
Common billing questions (and what usually causes them)
“Why did I get a bill if my plan says preventive visits are free?”
Most often:
Part of the visit became problem-focused (beyond preventive)
Labs were not preventive under your plan rules
A screening became diagnostic due to symptoms/history
The plan applied deductible/coinsurance
The claim processed out-of-network due to plan network rules
“Why did I get multiple bills?”
Common reasons:
Clinic bill + outside lab bill
Imaging center bills separately
Specialist referrals create separate charges
Some services are bundled; others are itemized
“Why does the billed amount look so high?”
Healthcare claims often show a “billed charge,” but insurance negotiates an “allowed amount.” The allowed amount is usually what matters for in-network plans.
“My insurance denied it—now what?”
Denials often happen due to:
Missing referral/authorization
Wrong member ID (or coverage inactive)
Plan limitations (frequency limits)
Coding/claim data errors
Service not covered under that plan
11) What to do if you have a billing concern (Passion Health’s recommended path)
Passion Health provides a Billing Concerns form designed for patients to ask questions and upload documents. The form requests: name, phone, email, your question, and supporting documents such as EOBs/statements (with file upload options).
Use the Billing Concerns form when:
You want the billing team to review an EOB vs a statement
You need clarification on what a charge represents
You suspect an insurance processing issue
You want to attach proof (EOB, denial letter, receipt, statement)
What to upload (best results)
The bill/statement you received
The EOB from your insurance for the same date of service
Any denial letters or insurance messages
Screenshots of your insurance portal claim details (optional)
Pro tip: In your question, include:
Date of service
Location (Irving, Plano, Frisco, Prosper, Aubrey, Kemp, Kaufman, Flower Mound, Anna, Ennis, Mesquite, etc.)
Whether you were self-pay or used insurance
The exact issue (example: “Insurance says paid, but statement shows balance”)
12) How to avoid surprises: a simple pre-visit plan
Here’s a patient-friendly workflow that reduces billing confusion before it happens.
Step 1: Verify coverage
Passion Health encourages calling so the team can verify your coverage and guide you to the right location.
Ask:
“Are you in-network with my exact plan?”
“Is my visit type typically covered?”
“Do I need a referral from my PCP?”
Step 2: Ask how your appointment will be billed
Preventive only?
Problem-focused?
Both?
Step 3: Ask about likely add-ons
“If labs are ordered, will the lab bill separately?”
“If I need imaging, where is it done and how is it billed?”
Step 4: Bring your insurance card and updated info
Wrong member ID or outdated coverage causes avoidable denials.
Step 5: After the visit, watch for the EOB
Match the EOB to the statement. If they don’t line up, use the Billing Concerns form with uploads.
13) A clear comparison: Self-Pay vs Insurance (quick table)
14) FAQ: Quick answers patients ask most
Does Passion Health accept Medicare / Medicare Advantage?
Many Passion Health pages list Medicare and Medicare Advantage among accepted insurance categories.
Because Medicare plan types vary, always confirm your specific plan and location.
Can you help me understand my out-of-pocket cost before my visit?
That’s the goal of insurance verification—Passion Health specifically encourages patients to call so the team can verify coverage and guide you appropriately.
How do I pay my bill online?
Use the “Pay Your Medical Bill” button on Passion Health’s billing page.
Where do I send billing questions and upload EOBs?
Use the Billing Concerns form, which supports document uploads (EOBs, statements, etc.).
15) Patient-friendly closing: your best next step (based on your situation)
If you’re reading this because you’re trying to plan your costs, here’s the simplest decision tree:
You have insurance and want to use it:
Call to verify your specific plan + ask how the visit will be billed (preventive vs problem vs both).You’re uninsured or want straightforward pricing:
Ask about self-pay options and what add-on costs might apply (labs, vaccines, procedures).You received a bill and something doesn’t look right:
Submit your question through the Billing Concerns form and upload your statement and EOB so the billing team can review quickly.You’re ready to pay now:
Use the online bill pay option from the Pay Your Bill page.
Published by our experienced and dedicated Billing Team.
For more details about insurance coverage, self-pay options, or billing questions, please contact us at +1 214-666-6259.
You can also call to schedule your appointment today
