Financial Policy & Procedures

As a courtesy to our patients, we submit claims to all insurance companies provided we have complete and accurate information. To ensure your claim is submitted in a timely fashion, please make sure the following insurance information has been included in your registration process. It is our commitment to assist you in getting your claim processed, however, it is your responsibility to make sure we have accurate information. Without this information you will be responsible for payment.

Required Billing Information:

• A copy of your current insurance card
• Effective date of your insurance
• Complete name, address and telephone number of insurance company
• Name and address of policyholder
• Relationship to policyholder
• Secondary insurance, if applicable

No Insurance Coverage:

Payment at time of service is required! We offer a discount for payment at the time of your visit providing there is absolutely no insurance coverage. The discount will be discussed with our receptionist at time of check out. Other forms of payment are Visa, MasterCard, American Express, Discover and Debit Cards.

Payment Plans:

We recognize that healthcare costs can, at times, create a financial hardship, therefore, we are willing to visit with you to set up a payment plan to ease the financial burden of satisfying an account balance. All payments must be kept current and expected to be paid off within one year of date of service. Our account representatives will be happy to visit with you to determine a reasonable plan.

Workers' Compensation Claims:

We file workers' compensation claims, however, there are some requirements that must be satisfied before making your appointment.

• Patient must report the accident to his/her employer
• Once the claim has been accepted, you will be assigned a claim number
• Please bring claim number, date of injury along with name and address of your employer to your appointment

Failure to do the above may result in a denied claim

Motor Vehicle Claims:

• Present with valid insurance information
• Insured name
• Insurance company name and address
• Claim number, if known
• We will submit claim if insurance coverage is valid, however, if there is a problem getting the account paid, you will be responsible for payment.

Co-Payment:

Your insurance company requires you to pay your co-pay at time of service. Failure to do so is a violation of your contract with your insurance company. This concept was created by the insurance industry to lower your premium by requiring the patient to pay a co-pay at every visit. Physicians also agreed to lower the amount they would accept as payment in full from the insurance companies because they were promised they would save the cost of sending statements for co-pays. Please don't expect or ask us to "bill" you, since the cost of sending a statement is often times much more than your co-pay.

Deductible:

This is an often overlooked or misunderstood issue. When we subscribe to insurance coverage, we agree to a "deductible" amount. The deductible amount is always the patient's responsibility. Until the deductible amount is satisfied, your insurance is not responsible for payment, however, we will submit your claim to the insurance company so the amount will go towards satisfying your deductible.

Statements:

Billing statements are mailed once a month unless there is insurance pending and in that case, you will not receive a statement until we have been reimbursed by your insurance company. If after 60 days and we have not received payment from your insurance we will look to you, our patient, for assistance in getting your account paid.

Surgery Estimates:

Prior to your surgery, you will meet with our patient representative to review your surgical charges. You will be given a copy of a written estimate which will include all charges as we know them at time of scheduling. Please understand this is only an estimate and your procedure could change once the physician begins the surgery.

Often, insurance companies require prior authorization for diagnostic studies and/or surgical procedures. Please understand there may be times you don't have coverage for certain procedures, therefore, we ask you, our patient, to understand you will be liable for procedures not covered by your insurance.

Orthopedic Surgeons & Sports Medicine, PSC - Notice of Privacy Practices

HIPAA Privacy Notice

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