We understand that insurance is complicated; here are some tips to help.
Even though we participate with most of the major insurances plans vary within insurance companies. Therefore, please verify with your insurance that our doctors are on your plan and familiarize yourself with your benefits, restrictions, copays and deductibles.
If you are expecting a baby please notify your insurance and find out what their process is for getting your new baby on your insurance and designating one of our doctors as the baby’s primary care physician (PCP). This will make the payment for hospital and newborn visits go more smoothly.
If you are new to the area please verify with your insurance that our doctors are on your plan.
Unfortunately, due to the changes in the insurance environment we cannot provide service without accurate insurance information. The insurance companies, who control reimbursement, are very strict about effective dates, timely filing, patient names and date of birth. Any variation on these from their records will cause the claims to be denied; so we all have to be aware of this and act accordingly.
|Your responsibilities:||Our responsibilities:|
|Patient name on our records must match the insurance card. Make sure the insurance has the correct birthday for the patient and the parents.||We will record the patient’s name exactly as it appears on your insurance card and the date of birth you have provided. If the insurance card is not correct we still have to use it as is, until you can get it corrected with the insurance company or the claims will be denied.|
|You must know when your insurance became effective. That way you can provide us with the correct insurance information at the time of your service. You need to show the patient’s insurance card at every visit as proof of what insurance you want us to bill for you.||We bill your insurance for your service as a courtesy based on the information you provide at the time of service.|
|If your insurance changes or is discontinued, notify us immediately so that we may bill the correct insurance going forward.||For service already provided, we will bill the new correct insurance if we receive the new information within 30 days of the date of service. Resubmitting these claims is very labor intensive and very time consuming. We will cover that cost up to 30 days from the date of service. If we receive this information beyond 30 days of the date of service there will be a $75 fee to resubmit the claim. If you do not wish to pay this fee you can simply pay the cost of the service and we can bill your new insurance going forward.|
|Copays are to be paid at the time of service. This is according to your insurance agreement.||We accept cash, check, Visa, MasterCard, and Discover. If we need to bill you for the copay a billing fee of $25 will be added to your charge.|
|Deductibles are the total amount of covered medical expenses that must be paid by the patient before the insurance company begins paying benefits. After this requirement is reached, the insurer will begin paying according to terms of the contract (often 75%-85%) of covered medical costs.||We require a credit card on file to cover these costs.|
|Secondary insurances must be set up properly by you and your insurance broker or human resources representative. This is a great source of payment error and confusion. Please be aware of something called the BIRTHDAY RULE: see below Make sure you are not paying premiums for benefits you will not receive.||We will bill your secondary insurance according to information you provide, but many times there are errors with the insurance companies as to which is primary and which is secondary. They pay according to what is in their records no matter how we bill them. This often results in both paying as primary or both claiming that the other is primary and improper involuntary refunds. If errors persist with your secondary insurance we will suspend billing to them and ask you to pay the balance until there is resolution. These problems have become so prevalent that some offices no longer accept secondary insurances.|
Birthday Rule – the Birthday Rule is approved by the National Association of Insurance Commissioners (NAIC). The Birthday Rule indicates that the plan of the parent whose date of birth (month and day) falls earlier in the calendar year is the primary plan for dependent children. For example, if the mother’s birth date is June 10 and the father’s birth date is April 23, the father’s plan would be primary. If both parents have the same birth date, the health plan in effect for the longer period of time will be primary.
No insurance? No problem. We can work out a payment plan with you.