In compliance with this office’s contracts with your health insurance plans and Federal Regulations, personal identification information, health insurance card and demographics must be confirmed at each visit. Verifying this information at each visit also serves to protect our patients from the risk of medical identity theft.
Your CURRENT health insurance card and U.S. Government issued photo identification must be presented at each visit. We do ask that you verify and/or update your demographic information at each visit.
If you do not have your health insurance card and U.S. Government issued photo identification with you, you may be asked to re-schedule to a time at which you will be able to have this information with you for a visit.
Insurance is a contract between you and your insurance company. Your doctor is contracted with most local insurance plans. It is your responsibility to make sure your doctor is a contracted provider with your insurance. Although we may estimate what your insurance may pay, it is the insurance company that makes the final determination of your eligibility.
It is every patient’s responsibility to be aware of their benefits under their insurance plan and their financial obligations to the physician for services rendered i.e., copays, coinsurance, and deductible.
Please ensure that you notify the office with any changes to your health insurance.
Any insurance information provided to our office that is past the timely filing deadline (period in days in which a physician must submit a claim to the insurance after the date the services to a patient were provided) will result in a claim being denied and you will then be responsible for paying for that claim/services rendered.
If you have insurance coverage under a plan with which we do not have a contract, you will be treated as a cash pay patient and will be provided documentation to assist you in filing your claim
If you have a secondary insurance, you would like your claim to be sent to, please ensure you provide the office with the information and have your insurance card with you.
Our office verifies your insurance benefits prior to each visit. For your ESTIMATED anticipated out of pocket expenses please call the office the day before your visit. The insurance company, however, always states this disclaimer ‘verification of benefits is not a guarantee of payment.”
If you contact your insurance and they state your visit is “covered,” please ask them what your out-of-pocket costs for the visit will be. We are not able to accept a verbal communication that your insurance has stated you should not pay anything at the time of your visit.
Our office verifies your estimated out of pocket expenses through the insurance websites and at times by calling them, the information provided to you is based on that verification process.
You agree to pay any portion of the charges not covered by your insurance.
If your insurance requires a referral and/or pre-certification, it is your responsibility to make sure this has been done prior to the date of your visit.
This office is NOT able to verify your diagnostic lab or radiology benefits. Please check with your insurance company to verify what your schedule of benefits allows for any laboratory, x-ray, or other diagnostic studies that may be ordered by the doctor during your visit. These services will be billed separately by the laboratory or physician that performs these tests and are not covered by the payments that you make at this office.
Any insurance claims or problems associated with the laboratory must be directed to the insurance department of that laboratory and not our office.
If your insurance requires a specific lab be used you MUST inform the office (front desk, medical assistant, and your physician) of this to ensure your labs are sent to the correct lab.
We do not accept patients with Primary commercial insurance and Medicaid as secondary insurance or Medicare as primary and Medicaid as secondary insurance. If you add Medicaid as a secondary insurance after beginning care under a commercial plan (e.g., BCBS, Cigna etc.), you will be asked to transfer care.
Please make certain that you have a full understanding of your Medicare benefits and your financial responsibility if Medicare does not cover your services.
Payment is due at the time services are rendered (co-pay, coinsurance, and deductible). Patients are expected to pay their portion of the office visit bill at the time of their visit.
The patient or legal representative is responsible for all charges for any services rendered.
Your insurance coverage is an agreement between you and your insurance company.
“Non-covered” means that a service will not be paid under your insurance contract. If non-covered services are provided, you will be expected to pay for these services at the time they are provided, or at the time you/ or our office receives a statement or EOB (Explanation of Benefits) from your insurance provider denying payment.
Appeal procedures are available, and we will be happy to assist your appeal attempts, however we will not change any ICD-10 codes for your claim to be paid.
Our office will not under any circumstances falsify or change a diagnosis or symptom to convince an insurer to “pay” for care that is not covered, nor do we delete or change the content in the record that may prevent services from being considered covered.
If you are unsure whether your plan covers a specific service, it is your responsibility to contact your insurance company to determine and review your schedule of benefits to ascertain that the service is covered and medically necessary. If the service is subject to a deductible, you can clearly be informed of the extent of your financial responsibility.
At the time we receive your explanation of benefits from your insurance company, if there is a portion of the claim determined as your responsibility, a statement will be sent for payment immediately.
A fee of $35.00 for checks returned to us for insufficient funds will be charged to your account. Future services will require payment by cash, money order, or credit card for your payment obligations.
Some insurance companies will cover preventive/annual visits, and some will not.
It is your responsibility to know what healthcare benefits your insurance covers, prior to your visit.
If you need to discuss any health problems that require evaluation and management this must be documented separately to your annual wellness visit and appropriately billed for.
Your insurance company will not pay for additional problems that are addressed during the preventive/annual exam. You will need to make a separate appointment to discuss these problems with your physician.
Please do not ask our staff to change coding for the purpose of getting your insurance to make payment on services rendered