Non-Participating Insurance Plans
The financial obligations of patients
who are insured by carriers that the practice does not participate are
considered a Self-pay account. The insurance company will be billed as a
non-assigned claim as a courtesy to the patient with the patient paying the
clinic the amount in full. The insurance company will reimburse the patient on
non-assigned claims. If the clinic receives payment for a non-assigned claim,
the patient will receive a refund within 10 days.
Automobile Accident Cases
The patient will be treated as a
Self-pay account unless a subrogation agreement is provided by health
insurance. If a subrogation agreement is provided and the physician
participates with the insurance carrier, the health insurance is billed. If an
attorney is involved in the case, a letter of protection will be obtained
whether an insurance carrier is involved or not.
Patient Refunds
The following criteria must be met
prior to issuing a patient refund: The patient has not been seen in the office
for 90 days, there are no outstanding insurance claims on the patient’s account,
and there are no outstanding balances on the account.
Divorce Cases
In cases of divorce, the individual
who receives care is responsible for payment of co-pays, coinsurance, and
nonparticipating insurance balances at the time of service. We will not bill a
divorced spouse for the patient’s services.
Child-Custody Cases
The parent with primary custody is
usually the parent with whom the child lives and who usually brings the child to
the clinic for care. The custodial parent is responsible for payment at the
time of service whether the account is considered self-pay, participating
insurance, or nonparticipating insurance. If the non-custodial parent carries
the insurance on the child, the clinic will bill that insurance company. The
clinic does not get involved with divorce specifics, e.g., one parent pays 80%
and the other pays 20%. It is the parent’s obligation to work out an agreement
themselves or through the court system.
Referrals
If your insurance has designated a
primary care provider (PCP), you are required to have prior authorization from
your PCP prior to your clinic visit. If this authorization is not provided, you
will be asked to either reschedule your appointment or pay for your visit at the
time of service.
Insurance Card
Please bring your insurance card to
the clinic at the time of your appointment. Without the presence of an
insurance card, you will need to pay in full at the time of service. We will
provide you with a receipt, which you may submit to your insurance company
yourself.
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Patient Signature Date