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Insurance/Payment Policy

 

We are committed to providing you with the best health care possible. If you have health insurance, we are eager to help you receive the maximum benefits allowed. We have developed the following policies and practices with respect to payment and insurance to help achieve these goals.

First, there are some basic matters of which you should be aware:

As medical doctors, our relationship is with our patients, and not their insurance carrier. Your insurance coverage is determined by the contract between you, your employer, and the carrier. We cannot affect coverage decisions. Questions about coverage should be directed to your insurance carrier.

Before seeing the doctor, you must provide us with complete insurance information. Failure to do so will jeopardize your coverage with HMOs, PPOs and managed care companies, and you will be responsible for the charges.

Some carriers exclude some services or tests – such as well woman exams, or thin prep pap tests – from their coverage. We cannot change your insurance coverage.

Our fees are reasonable and customary for the locale, considered reasonable and customary by most carriers, and are covered up to the maximum allowable by those carriers. Occasionally a carrier wll partially deny a claim on grounds that fees are not reasonable. We have no control over these actions and cannot adjust our fees retroactively.

Ordinarily payment for our health services is due when services are rendered. We accept cash and credit cards for payment. If temporary circumstances hinder your ability to pay your account, we encourage you to contact our office for assistance in the management of your account.

If you are a member of a managed care plan for which we are a provider, we will file your claim electronically. Your co-payment and deductible are due at the time of service. If for any reason your insurance carrier denies coverage for your claim, you must pay for our services at our regular fee schedule rate.

It is also important to know that the lab fees are separate from our fees, as they are not part of this office. As such, they are subject to co-pays and deductibles.

Financial Considerations

In an effort to explain some of the policies related to fees and costs, we offer the following explanations.  Our business office is always happy to help you understand and discuss your bill.  We encourage you to review all statements for accuracy of services provided and subsequent bills.

Our Fees

Our fees are determined by the individual care given and are competitive with area specialists. Health insurance may not cover the entire cost of your care. Copays are expected to be paid at the time of service. We encourage our patients to contact their insurance carrier to determine what is covered by their plan. Remember that your account is your responsibility even though you have insurance coverage.

If you are a new obstetric patient, you will meet with our Patient Account Representative following your second or third visit. And at that time the Patient Account Representative will review verified insurance carrier coverage and expected cost for your obstetric care and delivery.  Otherwise, if you have questions regarding your account or need to set up a financial arrangement, please request to meet with the Patient Account Representative either during a visit or by scheduling an appointment.

Should you require surgery, we will contact your insurance company to obtain pre-authorization prior to surgery and the estimated patient balance due for the procedure. Obtaining pre-authorization does not mean that your surgery will be covered at 100%.  You will meet with the Patient Account Representative the same day as your pre-op appointment with your physician   to explain your benefits and collect applicable co-pays, co-insurances and deductibles prior to your surgery.

Understanding Your Insurance

Not all office visits are covered by your insurance policy so it’s important to be familiar with your coverage. You will most likely be responsible for charges such as deductibles, co-insurance, maximum out- of- pocket, and copays. If you are unsure about the details of your policy, please contact your insurance company prior to scheduling an appointment.

  • deductible: the amount you pay out- of- pocket, each year, before your insurance starts to pay medical expenses.
  • Co-Insurance: the rate at which you and your insurance split medical expenses after you have met your deductible.
  • Maximum out- of- pocket: the most you would have to pay for medical expenses, at which time your insurance should pay, in full, for all remaining expenses.
  • Copay: the set deposit amount for a service, typically an office or ER visit, that your insurance requires you to pay. If you have a copay for office visits, please make that payment when you check in for your visit.

Understanding Your Office Visit

An annual exam (preventive, routine, wellness and well woman) includes an age-appropriate history & physical exam, risk factor review, ordering of routine laboratory tests, along with general discussion about healthy lifestyle and preventive care. Lab tests ordered as part of an annual exam are billed as preventive care services. All laboratory tests are billed for disease prevention, not to monitor a diagnosed disease.  Generally, lab tests are a covered benefit under your plan but NOT paid at 100% and are frequently subject to plan deductible and copay requirements.  You will be billed for any related balances due for the lab services directly from the laboratory providing the diagnostic analysis.

problem-oriented visit addresses specific problems (menopause, depression, bleeding, etc.).

How your office visit is billed (annual or problem) is determined by what happens during your visit, typically where the most focus is directed. However, it is possible that your visit may include both annual and problem services, which will be billed accordingly.

If you have questions related to the billing of your visit, please ask to speak with one of our billing specialists.

Your Bill

We are very concerned about rising medical care costs and we make every effort to keep costs down. Payment at the time of services can help reduce these costs. Payment for non-covered services is expected at the time of service. We do accept cash, personal checks and credit cards.

We submit claims for all procedures, surgeries and obstetrical services. Statements are mailed monthly for any balance due on your account. Payment of your account balance is expected upon receipt of the bill. Patient due balances over 60 days may be subject to a finance fee. Again, if you have questions regarding your account or need to set up a financial arrangement, please request to meet with the Patient Account Representative either during a visit or by scheduling an appointment.  We are here to help!