If you are insured, we will bill those insurance plans with whom we have an agreement, and we will do all the paperwork for you. If you have a PPO or HMO insurance plan, we will collect the required CO-PAYMENT and any deductible that is due at the time of visit. In the event that your health plan determines a service to be "non-covered," we will bill you, and payment is due upon receipt of that statement. Any amount not paid by your insurance company within 30 days will be billed to you for payment, and we ask that you assist us in contacting your insurance carrier for payment status. If your insurance coverage is with a plan that we do not have an agreement, we will send the claim in for you, and the insurance company might send the payment directly to you, on an unassigned basis. In this case, the charges for your care and treatment are due at the time of the service.
If you do not have insurance, payment in full is expected at the time of service. If you have a financial hardship, special financial arrangements may be made with our financial counselor to discuss a payment plan option.
We are participating Medicare providers. We accept Medicare assignment. If you have Medicare, we will bill your Medicare insurance and supplemental carrier for you. We will collect co-payments at the time of service and bill you for the incurred balance. In the instance that you are covered by Medicare and your secondary insurance is a PPO or HMO plan, we will handle the insurance billing for you with benefits assigned to our office.
In today's modern insurance world it seems everyone has a different type of insurance coverage requiring special considerations. It is the patient's insurance plan, therefore the patient's responsibility to inform the office prior to making an appointment as to the type and special circumstances of their plan. We are a member of most groups but we do not belong to all insurance plans. Our doctors are participating physicians with Medicare program. We will submit a claim for your services to Medicare, and you will be responsible for payment of any deductible, co-payment, and/or non-covered services.
Please remember that insurance is considered a method of reimbursing the patient for fees paid to the doctor and is not a substitute for payment. Some companies pay fixed allowances for certain procedures and others pay a percentage of the charge. It is your responsibility to pay any deductible amount, co-insurance or any balance not paid by your insurance company.
When questions on insurance matters arise, please feel free to discuss them with one of our patient account representatives. They will be happy to help you receive maximum benefits; however, the agreement by the insurance company to pay for your medical care is a contract between you and your insurance company.
We are asked many questions as they relate to insurance. Following are some of the more frequently asked insurance questions.
Question: Why don’t all doctors charge the same fee?
Answer: Physicians’ fees vary for many reasons. A doctor who practices in a city may have higher expenses than one in a small town. One neighborhood may have higher rent and other expenses than the other. And a specialist who sees fewer patients because more time must be spent with each one, and who has put in extra years of advanced study and spent more for scientific equipment, will normally charge higher fees. Additionally, medical liability insurance costs are rapidly increasing and vary a great deal by geographical location
Question: Why do doctors have different fees for different patients?
Answer: There are many reasons. The nature of the illness and the treatment required affect the fee charged. Obviously, you pay more for major surgery than for having a finger splinted in the doctor’s office. As a rule, fees are higher when the treatment needed is more difficult, takes more time, or requires greater skill.
Question: Will my insurance pay all of my medical bills?
Answer: Not always. As a matter of fact, for most patients it won’t.
Question: Why not? Isn’t that what insurance is for?
Answer: No. The fact is that most insurance-life, fire, theft, liability-merely helps the purchaser meet the expense of some misfortune. Life insurance won’t support the surviving beneficiary for the rest of his or her life. Fire insurance on your home won’t pay for replacing everything that is destroyed. It is the same with medical insurance, which is usually designed to help you meet medical bills- not to pay 100 percent of them.
Question: Why don’t insurers tell you you’re not fully covered?
Answer: Nobody sells insurance by calling attention to what it does not do. The insurers- commercial companies, Blue Cross and Blue Shield, and even government agencies-see no reason to remind the purchaser of what their policies do not cover.
Question: Isn’t this dishonest?
Answer: It may be misleading, but it is not illegal-because somewhere in the fine print of every insurance policy will be a statement about the coverage it provides. It may be hard to find and even harder to understand, but it will meet the legal requirements for informing the purchaser of the policy’s coverage. What does seem wrong is that some insurers are less than truthful in replying to complaints about their partial payments for doctor’s bills. Frequently the insurers-even government agencies- say flatly that the physician has overcharged the patient. If they were truthful, they would simply say, “Under your policy’s coverage, this is the maximum amount we will pay for the treatment you received.”
Question: Why do insurers say doctors are overcharging?
Answer: Because they don’t want to admit they are underpaying. Their accusation of overcharging is often made when a policy promises reimbursement for bills based on the doctor's’ "usual and customary and reasonable” charges. Originally, the term used was “usual and customary,” and it meant the customary charge of a physician usually made to patients receiving a particular treatment.
Over the years, the insurers gradually changed the meaning of the term. First they ruled that “usual and customary” did not mean what it said, but meant the average of all fees charged for a particular treatment by all doctors in a particular region. They said they would not pay even this average amount but just a percentage of it.
Stop and think about this. It means that the insurers, on their own, decided they would pay for only part of your doctor’s bills. It does not mean, as they often say, that your doctor has overcharged you; to means that the insurers are underpaying you, assuming that you will not realize it and that you cannot do anything about it.
One more point. Some insurers lag as much as 18 months behind in calculating averaged fees. This causes you a further loss because your insurance reimbursement is not a percentage of average fees a year and a half old-, which may not reflect your doctor’s present charges.
The insurers also changed their policies to say “usual and customary and reasonable” charges. A doctor’s fee can be usual and customary, but the insurers can call it unreasonable and refuse to pay it. Since nobody can guess what the insurers will decide is unreasonable, a policy holder often does not learn that an insurance payment will be too little until a notice arrives claiming falsely that the doctor’s bill is an overcharge.
Question: Why don’t doctors fight such practices?
Answer: Many doctors have objected individually, and also have complained to their medical societies. So far, their efforts have been unsuccessful. What is needed to correct this unfair practice is a vigorous and concerted public outcry.
Question: What can I do about it?
Answer: If you medical insurance pays less than you expected, complain to your insurer, to your state insurance department, to your state legislators and your representatives in Congress, and to any other consumer protection agencies or citizens watchdog groups in you community or state.
Question: That a long-range project. What can I do right now?
Answer: Ask your doctor what your bill will probably be and what charges there may be hospitalization, anesthesia and other medical services. This will give you an ides of what your insurance will not cover so; you can plan to meet whatever problems there may be. Verify insurance coverage before a hospitalization or a procedure so you know what you will have to pay.
Your medical insurance is an agreement between you and the insurance carrier designed to help you with doctors’ bills. Paying the bills is your responsibility, of course but you should get as much reimbursement as you are entitled to from the insurer. Almost all doctors will help you collect from insurance carriers, although this is not their responsibility.
One final reminder. Do not be afraid to talk over your bill with your doctor ahead of time. This is your right and privilege.
Every effort is made to keep down the cost of your medical care. You can help by paying at the time of your office visit. We accept cash, checks, Master Card and VISA.
If you do not have insurance, payment in full is expected at the time of service. If you have a financial hardship, special financial arrangements may be made with our financial counselor to discuss a payment plan option.
We are participating Medicare providers. We accept Medicare assignment. If you have Medicare, we will bill your Medicare insurance and supplemental carrier for you. We will collect co-payments at the time of service and bill you for the incurred balance. In the instance that you are covered by Medicare and your secondary insurance is a PPO or HMO plan, we will handle the insurance billing for you with benefits assigned to our office.
In today's modern insurance world it seems everyone has a different type of insurance coverage requiring special considerations. It is the patient's insurance plan, therefore the patient's responsibility to inform the office prior to making an appointment as to the type and special circumstances of their plan. We are a member of most groups but we do not belong to all insurance plans. Our doctors are participating physicians with Medicare program. We will submit a claim for your services to Medicare, and you will be responsible for payment of any deductible, co-payment, and/or non-covered services.
Please remember that insurance is considered a method of reimbursing the patient for fees paid to the doctor and is not a substitute for payment. Some companies pay fixed allowances for certain procedures and others pay a percentage of the charge. It is your responsibility to pay any deductible amount, co-insurance or any balance not paid by your insurance company.
When questions on insurance matters arise, please feel free to discuss them with one of our patient account representatives. They will be happy to help you receive maximum benefits; however, the agreement by the insurance company to pay for your medical care is a contract between you and your insurance company.
We are asked many questions as they relate to insurance. Following are some of the more frequently asked insurance questions.
Question: Why don’t all doctors charge the same fee?
Answer: Physicians’ fees vary for many reasons. A doctor who practices in a city may have higher expenses than one in a small town. One neighborhood may have higher rent and other expenses than the other. And a specialist who sees fewer patients because more time must be spent with each one, and who has put in extra years of advanced study and spent more for scientific equipment, will normally charge higher fees. Additionally, medical liability insurance costs are rapidly increasing and vary a great deal by geographical location
Question: Why do doctors have different fees for different patients?
Answer: There are many reasons. The nature of the illness and the treatment required affect the fee charged. Obviously, you pay more for major surgery than for having a finger splinted in the doctor’s office. As a rule, fees are higher when the treatment needed is more difficult, takes more time, or requires greater skill.
Question: Will my insurance pay all of my medical bills?
Answer: Not always. As a matter of fact, for most patients it won’t.
Question: Why not? Isn’t that what insurance is for?
Answer: No. The fact is that most insurance-life, fire, theft, liability-merely helps the purchaser meet the expense of some misfortune. Life insurance won’t support the surviving beneficiary for the rest of his or her life. Fire insurance on your home won’t pay for replacing everything that is destroyed. It is the same with medical insurance, which is usually designed to help you meet medical bills- not to pay 100 percent of them.
Question: Why don’t insurers tell you you’re not fully covered?
Answer: Nobody sells insurance by calling attention to what it does not do. The insurers- commercial companies, Blue Cross and Blue Shield, and even government agencies-see no reason to remind the purchaser of what their policies do not cover.
Question: Isn’t this dishonest?
Answer: It may be misleading, but it is not illegal-because somewhere in the fine print of every insurance policy will be a statement about the coverage it provides. It may be hard to find and even harder to understand, but it will meet the legal requirements for informing the purchaser of the policy’s coverage. What does seem wrong is that some insurers are less than truthful in replying to complaints about their partial payments for doctor’s bills. Frequently the insurers-even government agencies- say flatly that the physician has overcharged the patient. If they were truthful, they would simply say, “Under your policy’s coverage, this is the maximum amount we will pay for the treatment you received.”
Question: Why do insurers say doctors are overcharging?
Answer: Because they don’t want to admit they are underpaying. Their accusation of overcharging is often made when a policy promises reimbursement for bills based on the doctor's’ "usual and customary and reasonable” charges. Originally, the term used was “usual and customary,” and it meant the customary charge of a physician usually made to patients receiving a particular treatment.
Over the years, the insurers gradually changed the meaning of the term. First they ruled that “usual and customary” did not mean what it said, but meant the average of all fees charged for a particular treatment by all doctors in a particular region. They said they would not pay even this average amount but just a percentage of it.
Stop and think about this. It means that the insurers, on their own, decided they would pay for only part of your doctor’s bills. It does not mean, as they often say, that your doctor has overcharged you; to means that the insurers are underpaying you, assuming that you will not realize it and that you cannot do anything about it.
One more point. Some insurers lag as much as 18 months behind in calculating averaged fees. This causes you a further loss because your insurance reimbursement is not a percentage of average fees a year and a half old-, which may not reflect your doctor’s present charges.
The insurers also changed their policies to say “usual and customary and reasonable” charges. A doctor’s fee can be usual and customary, but the insurers can call it unreasonable and refuse to pay it. Since nobody can guess what the insurers will decide is unreasonable, a policy holder often does not learn that an insurance payment will be too little until a notice arrives claiming falsely that the doctor’s bill is an overcharge.
Question: Why don’t doctors fight such practices?
Answer: Many doctors have objected individually, and also have complained to their medical societies. So far, their efforts have been unsuccessful. What is needed to correct this unfair practice is a vigorous and concerted public outcry.
Question: What can I do about it?
Answer: If you medical insurance pays less than you expected, complain to your insurer, to your state insurance department, to your state legislators and your representatives in Congress, and to any other consumer protection agencies or citizens watchdog groups in you community or state.
Question: That a long-range project. What can I do right now?
Answer: Ask your doctor what your bill will probably be and what charges there may be hospitalization, anesthesia and other medical services. This will give you an ides of what your insurance will not cover so; you can plan to meet whatever problems there may be. Verify insurance coverage before a hospitalization or a procedure so you know what you will have to pay.
Your medical insurance is an agreement between you and the insurance carrier designed to help you with doctors’ bills. Paying the bills is your responsibility, of course but you should get as much reimbursement as you are entitled to from the insurer. Almost all doctors will help you collect from insurance carriers, although this is not their responsibility.
One final reminder. Do not be afraid to talk over your bill with your doctor ahead of time. This is your right and privilege.
Every effort is made to keep down the cost of your medical care. You can help by paying at the time of your office visit. We accept cash, checks, Master Card and VISA.