For your convenience, we are an in-network provider for numerous PPO's and HMO's. If we have a contract with your insurance carrier, we will file medical claims directly with them. Our office will also file insurance claims for hospitalizations. We file primary insurance. Insurance claims are filed a maximum of twice, and then payment will be expected from the patient. In order to submit your claim, we must have a current copy of your insurance card on file. If you fail to make us aware of changes to your insurance carrier at the time of your visit, the responsibility for payment for the office visit and subsequent reimbursement from your new insurance carrier will be yours. All outstanding balances and co-pays will need to be paid before you can see the doctor at each office visit unless prior arrangements have been made with the billing office or office manager.
Please note that there are certain services and items that may not be reimbursed by your insurance carrier, but are the responsibility of the patient to pay. Typical items the patient will be expected to pay include:
- Office visit co-pays
- Co-insurance payments for visits (example: 80%/20% insurance plans)
- All office visits prior to the unmet portion of the yearly deductible
- Office visits prior to insurance coverage or after coverage termination
- Any non-insurance covered service
Our contract with your carrier, and your agreement with your insurance provider require both of us to follow certain procedures when obtaining laboratory or x-ray services. The insurance plan may require use of specific laboratories, hospitals or x-ray facilities, and some plans may have restrictions on seeing specialists without prior approval. You will be responsible for obtaining a referral to see our physicians if your plan requires it. Also, not all PPO's and HMO's provide the same coverage for preventative health visits (check-ups), immunizations or laboratory tests. We strongly recommend that you contact your insurer prior to your visit to make sure that you know what visits and procedures will be covered.
