Patient Financial Policy
We participate and accept assignment from most major payors, which means covered charges will be paid directly to us. If we do not participate with your insurance plan, you may still choose to be seen by the practice. As a courtesy to you, we will file a claim with your insurance carrier on your behalf. Any remaining balance will be billed to you once we have received payment from your insurance carrier.
Due to current federal and insurance regulations, all co-payments, co-insurance and deductibles are collected at time of service. As we are colorectal specialists, it is very likely we will perform a diagnostic procedure to assist us in diagnosing your medical condition at the time of your office visit. These procedures may include an anoscopy, proctoscopy, and/or a flexible sigmoidoscopy. Your insurance carrier may define them as a “surgical procedure” and your explanation of benefits may reflect their use of this term. Please note, your insurance carrier may charge an additional copayment or deductible for these services. We accept cash or checks, and for your convenience, Visa, MasterCard, American Express and Discover. Additional fees, which typically are not covered by insurance plans will be charged for services such as copying of medical records, and completion of disability forms. A fee of $35.00 will be charged for checks returned for insufficient funds. Delinquent accounts sent to an outside collection agency for further collection efforts will incur an added collection fee. We encourage you to contact us promptly for assistance in the management of your account. We are here to help you and will be happy to answer any questions you may have about your treatment or insurance coverage.
Your insurance policy is an agreement between you and your insurance company. The policy lists a package of medical benefits such as tests, drugs and treatment services. The insurance company agrees to cover the cost of certain benefits listed in your policy. These are called “covered services.”
Your policy also lists the kinds of services that are not covered by your insurance company. You have to pay for any uncovered medical care that you receive. Keep in mind that a medical necessity is not the same as a medical benefit. A medical necessity is something that your doctor has decided is necessary. A medical benefit is something that your insurance plan has agreed to cover. In some cases, your doctor might decide that you need medical care that is not covered by your insurance policy.
Insurance companies determine what tests, drugs and services they will cover. These choices are based on their understanding of the kinds of medical care that most patients need. Your insurance company’s choices may mean that the test, drug or service you need isn’t covered by your policy.
Your doctor will try to be familiar with your insurance coverage so he or she can provide you with covered care. However, there are so many different insurance plans that it’s not possible for your doctor to know the specific details of each plan. By understanding your insurance coverage, you can help your doctor recommend medical care that is covered in your plan.
- Take the time to read your insurance policy. It’s better to know what your insurance company will pay for before you receive a service, get tested or fill a prescription. Some kinds of care may have to be approved by your insurance company before your doctor can provide them.
- If you still have questions about your coverage, call your insurance company and ask are presentative to explain it.
- Remember that your insurance company, not your doctor, makes decisions about what will be paid for and what will not.
- Remember that your physician, not your insurance company, makes medical decisions and recommendations about what will benefit your health status.
Most of the things your doctor recommends will be covered by your plan, but some may not. When you have a test or treatment that isn’t covered, or you get a prescription filled for a drug that isn’t covered, your insurance company won’t pay the bill. This is often called “denying the claim.” You can still obtain the treatment your doctor recommended, but you will have to pay for it yourself.
If your insurance company denies your claim, you have the right to appeal (challenge) thedecision. Before you decide to appeal, know your insurance companies appeal process. This should be discussed in your plan handbook.
Source: American Academy of Family Physicians, 2001