Today's health insurance policies and coverage offer more options than ever before. Each patient is responsible for knowing his or her plan's benefits package, co-payment, deductible, non-covered services, and restrictions. You can usually obtain this information by calling the 800 number listed on the back of your insurance card or by visiting their website. Many plans have participating or preferred practitioners. We participate in most area health plans, but will be glad to research any others if your plan is not listed below. Please be sure to bring your insurance card with you when you visit us.
We realize that rising healthcare costs make insurance cost-prohibitive for some people in our community and we would like to assist by offering a discount plan for our services. Please click here for details on our Medical Discount Program.
PPO members are given a Directory of Preferred Practitioners who are plan participants (members may have an option to see doctors who are not in this network of Practitioners, but the option will be at a different benefit level). Some PPOs require subscribers to select a primary care physician and to have a referral from that physician before seeing any specialist. PPO policies usually require a co-payment, deductible or co-insurance amount from the patient that is due at the time of each visit. The co-pay amount usually appears on your insurance card. We will collect your co-payment, deductible or co-insurance amount and file your claim with your PPO plan. After the claim has been processed, we will send you a statement for any balance due from you. Some plans are fully funded by the insurance company or employer and do not require any payment at the time of service.
HMO plans require that patients have a primary care physician who is a participating provider with the HMO. HMOs also require a referral from your primary care physician before you can seek health care (including X-ray, lab, or specialty services) from any other provider. If we are designated as your PCP and you seek such care on your own, we cannot provide referrals. We are not allowed to provide retroactive referrals. A co-pay due at time of service is required for every visit. There may be a higher co-pay if you are being seen by us as on an urgent care basis and we are not your primary care physician. There may be services that are "non-covered" by your HMO and you should make yourself familiar with those. If any non-covered service is provided, payment is due at the time of your visit.
For patients with Health Savings Accounts, we collect payment for the office visit and file a claim with your plan on your behalf. Because you are ultimately responsible for payment, you will receive a statement from us if further payment is due. Most plans are associated with a health insurance company and if we are a participating provider with that plan, you will only be charged our contracted rates for services covered.
For patients with such coverage, we collect 20% or 30% of charges at the time of your visit and file a claim with your plan on your behalf. Because you are ultimately responsible for payment, you should contact your plan if it does not pay your claim. You will receive a statement from us until the account is paid in full.
If you have Medicare, we will bill your visit to Medicare. If Medicare has your supplemental insurance information, they will send your claim directly to the supplemental carrier. Please provide our staff with your supplemental policy information, if applicable. All unpaid balances may become your responsibility, depending on your plan type and benefits.
If the bill is related to treatment for an on-the-job injury or accident, we will file a claim with your employer or your employer's workers' compensation insurance carrier after authorization. Claims that are denied may ultimately become your responsibility, but we'll work with you on payment options.
We recognize the needs of patients who may be uninsured, have high deductibles or the advantage of a flexible spending account. For patients without insurance coverage, payment is expected at the time of service, but we are pleased to offer discounted rates for office visits for self-pay patients. To be eligible for the discounted rate, full payment is required at the time of service and we will be unable to file the claim with insurance.
If you have a question about a bill you have received or our billing practices, please contact our Billing Department:
(803) 329-3103 ext. 228