Insurance Coverage

It is your responsibility to be aware of your insurance coverage, policy provisions, exclusions and limitations as well as authorization requirements. This information is furnished by your insurance carrier.
We attempt to verify that your coverage is valid at the time of the visit. However, if your coverage is not in effect at the time of the visit, the financial responsibility for payment is yours.

Insurance Changes

If you have had any changes in your insurance coverage – even if there is only a small change in the co-payment amount or a change in the expiration date of the policy – you must notify us. Even a small discrepancy on the claim form can lead to a claim denial.

Co-Payments, Co-Insurance and Deductibles

Co-insurance and co-payments are the patient’s responsibility. Co-payments are due at the time of the visit. If you do not make your co-payment at the time of your visit, you will be charged a $10.00 fee.

Deductibles are the patient’s responsibility. The deductible is determined by the contract you have with your insurance carrier. We do not know how much each person’s deductible is and how much has been met at the time of your visit.

Referrals

It is your responsibility to obtain referrals if required to do so by your plan.

Well Visits

It is your responsibility to be aware of how many well visits per year that your insurance will cover.
Full payment at the time of visit will be required for well visits not covered by your plan.
If you are being seen for a well visit, the physician cannot change it to “sick” visit so that it will be covered.

Obstetric Ultrasounds

It is your responsibility to be aware of how many obstetrical ultrasounds per pregnancy that your insurance will cover.
Full payment at the time of visit will be required for obstetric ultrasounds not covered by your plan.
– Oxford: Oxford Health Plans will currently cover three (3) obstetrical ultrasounds. Any amount after three (3) require authorization which you are required to obtain.
– HIP will currently cover three (3) obstetrical ultrasounds. Any amount after three (3) require authorization which you are required to obtain.

Non-Covered Services

All patients are responsible for “non-covered” services if denied by their insurance carrier.

Insurance Requests

You are responsible for responding to any requests from the insurance company for further information. Not doing so will result in a claim denial and you will be responsible for payment.

Insurance Payments Sent to You

If insurance payments are sent to you erroneously, you are responsible for forwarding them to our office.

Late Fees and Account Balance Information

For every 30 days that your account balance is past due there may be an additional $10.00 late fee added to your account.
We reserve the right to charge you an additional fee of $30.00 or more should your account be referred to a collection agency.

Secondary and Tertiary Insurance

We will not submit your claims to your secondary or tertiary insurance company for a copayment balance. We will provide you with the paperwork needed to submit the claim personally. You must take care of your copayment at the time of your visit.

* We emphasize that as a medical care provider, our relationship is with you and not your insurance company. It is your responsibility to know your policy.