Health insurance is a contract between the patient and their insurance carrier. The insurance policy lists a package of medical benefits such as treatment services, tests, office visits and therapies. The insurance company agrees to cover the cost of certain benefits listed in your policy. These are your covered services.
Your policy also lists the kinds of services that are not covered by your insurance company. These are your exclusions. You must 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, therapies and services they will cover. Your insurance company’s choices may mean that the test, therapy or service you need isn’t covered by your policy.
By understanding your insurance coverage, you can help our providers recommend care that is covered in your plan. We will try to be familiar with your insurance coverage so we can provide you with covered care. However, there are so many different insurance plans that it’s not possible for our providers to know the specific details of each 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 a representative to explain it. Please use this Insurance Verification form that has a comprehensive list of questions to ask the representative.
Your insurance company, not our providers, makes decisions about what will be paid and what will not.
Our providers, not your insurance company, makes medical decisions and recommendations about what will benefit your health.
Some services, tests or therapies recommended by your provider may not be covered by your insurance policy. When you have a test or treatment that isn’t covered, your insurance company won’t pay the bill. You can still obtain the treatment your doctor recommended, but you will have to pay for it yourself. Claims may not be resubmitted with different codes if they have been denied for lack of coverage.
As a courtesy we will submit your claims directly to any Contracted Insurance Provider, provided the information we have obtained from you is accurate and complete, however the patient assumes responsibility for all unpaid balances, co-payments, and deductibles due, as well as any non-covered service by the insurance company, including cost of collection. It is the patient’s responsibility to provide the most current insurance information to our office at the time services are rendered. A rebilling charge of $10.00 will be added if claims need to be resubmitted to the correct insurance company.
It is your responsibility to know the limits and exclusions to your insurance coverage.
PAYMENT: If your insurance coverage has not been verified prior to visit, we charge cost of the full visit at the time of the visit. We accept cash, checks, Visa, Mastercard and Discover.
24 Hour Cancellation Notice
A fee of $100 will be charged for cancellations or no shows made less than 24 hours from your first scheduled appointment.
Future appointments will be assessed $75 for the same.