Understanding Your Insurance Coverage
Your insurance policy is an agreement between you and your insurance company. The policy lists a package of medical benefits such as tests, drugs and treatment services. The insurance company agrees to cover the cost of certain benefits listed in your policy. These are called “covered services”.
Your policy also lists the kinds of services that are not covered by your insurance company. You have to 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, drugs and services they will cover. These choices are based on their understanding of the kinds of medical care that most patients need. Your insurance company’s choices may mean that the test, drug or service you need isn’t covered by your policy.
By understanding your insurance coverage, you can help your doctor recommend medical care that is covered in your plan. Your doctor will try to be familiar with your insurance coverage so he or she can provide you with covered care. However, there are so many different insurance plans that it’s not possible for your doctor 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.
• Remember that your insurance company, not your doctor, makes decisions about what will be paid for and what will not.
• Remember that your physician, not your insurance company, makes medical decisions and recommendations about what will benefit your health status.
Most of the things your doctor recommends will be covered by your plan, but some may not. When you have a test or treatment that isn’t covered, or you get a prescription filled for a drug that isn’t covered, your insurance company won’t pay the bill. This is often called “denying the claim.” You can still obtain the treatment your doctor recommended, but you will have to pay for it yourself. If your insurance company denies your claim, you have the right to appeal (challenge) the decision. Before you decide to appeal, know your insurance company’s appeal process. This should be discussed in your plan handbook. Also, ask your doctor for his or her opinion.
We are committed to providing you with high quality medical services regardless of our participation status in your insurance plan. We will help you receive your maximum allowable insurance benefits. Our surgeons currently only participate in Medicare but they do not accept Medicare Assignment. Please refer below for an explanation.
Please be aware that due to current federal regulations, we are obligated to collect all applicable co-payments, co-insurance, and bill for all services. To assist you in understanding your financial responsibilities, please refer to the following:
Due to the stringent regulations governing the healthcare industry and the complex nature of our surgical practice, the office requires the Patient Registration Form be completed in full and copies of the front and back of each patient’s insurance card(s) be obtained (including secondary insurance information). This includes proper identification numbers, subscriber data and complete insurance claim address. Patients who are unable to provide this complete information will be fully responsible for all charges. Should complete information be provided subsequent to examination or treatment, we will process claims on behalf of the patient to facilitate reimbursement for only hospital procedures and surgeries.
For your convenience payments may be made in the form of Master Card, Visa, Discover, American Express, and check or cash.