Patient Financial Policy

Transcription

1 Patient Financial Policy We want you to concentrate on feeling better instead of worrying about how you're going to pay your bill. Please review this Patient Financial Policy for answers to commonly asked questions, such as: How do I prepare for my appointment? How will I be billed? What are The Sports Medicine Clinic s financial expectations of me? If you still have questions, please call us. Billing Checklist Before Your Appointment 1. Contact your insurance company to make sure you understand your benefits and your plan s requirements. For physical therapy, be sure you know your insurance company s annual visit, or dollar, limits. 2. Confirm that The Sports Medicine Clinic and/or Advanced Manual Therapy are contracted providers for your plan. If SMC is not a preferred provider on your plan, you can still see one of our healthcare providers, but the amount you are responsible for could be greater. 3. If your insurance plan requires pre-certification, prior authorization or a referral, please discuss with your primary care physician prior to scheduling an appointment with one of our specialists. It is your responsibility to ensure that your plan has pre-certified or preauthorized your services before you receive them. At Check-In 1. Bring your driver's license or other form of government-issued identification. 2. Bring all of your current health insurance cards to your appointment. Patients who do not bring valid insurance card(s) to their appointment must pay in full by cash or by debit or credit card at time of service. 3. If you are a returning patient, let us know if your personal or insurance information has changed since your last visit. 4. Be prepared to pay your co-pay and/or co-insurance and any outstanding bills from previous care you received at The Sports Medicine Clinic. 5. Note to divorced parents of dependents: Unless you provide us with a court order, the person listed on the patient registration as the Responsible Party is responsible for the bill. If the Responsible Party is not you and that person does not pay the bill, you agree to pay the 1

2 Definitions bill. Divorced parents must work out any disagreement of who is responsible for the charges without SMC involvement. Health insurance seldom covers 100% of your healthcare costs. The costs that are not covered are called out-of-pocket expenses: 1. Deductible: the amount of money you must pay before your insurance starts paying. 2. Co-pay: the amount of money you pay directly to the healthcare provider at every visit. 3. Co-insurance: The remaining balance of your bill after insurance has paid. After Your Visit 1. Respond promptly to any requests from your insurance company to ensure timely resolution of your bill, especially if your insurance company sends you an incident report asking for the details of your injury. The insurance needs the completed incident report from you before they will pay your claim. 2. If your statement shows a balance due, please pay it in full. Patient balances not paid within 30 days are charged a 1% interest per month. Accounts not paid in full in 90 days are sent to our collection agency. 3. Call us if you have any questions or concerns about a bill or to make payment arrangements if you cannot pay your balance in full. Contact: Billing Department Hours: Mon. - Fri., 7 a.m. - 5 p.m. Phone: (206) Patients with Insurance We are pleased to bill your insurance for you, provided you give us accurate and complete insurance information when you schedule your appointment. We do not bill insurances that pay you directly rather than send payment to our office. We also do not bill insurances that we are unable to verify, such as foreign insurances or insurance plans we consider unlikely to pay for the services we provide. The responsibility of providing evidence of eligibility and benefits rests with you. Paying Your Bill While The Sports Medicine Clinic bills insurance on your behalf, the ultimate responsibility for your bill is yours. 2

3 Co-pays, Deductibles and Co-insurance If you are a new patient, we verify your insurance eligibility and benefits before your first appointment. Periodically we also re-verify insurance coverage for existing patients, particularly for physical therapy patients approaching their annual visit maximums. It is your responsibility to understand what services are covered under your medical insurance policy. Co-pays are due at the time of your appointment. We strive to present you with a bill of our services at check-out, reflecting the charges for your visit and the estimated balance of your account after insurance has paid. If we are able to determine your deductible and co-insurance at check-out, we ask that you pay your balance in full before you leave the Clinic. In case you overpay you will receive a refund promptly. Orthotics must be paid for when you pick them up, unless we have evidence that your insurance covers them in full. We accept cash, checks, debit cards, Visa and MasterCard. Laboratory testing ordered by your physician may or may not be covered by your insurance plan and are billed independently by the specific lab utilized. Please discuss any concerns of coverage prior to services rendered as we are unable to alter coding retrospectively. Please respond to any lab discrepancies or concerns directly to the lab billing department. Pay-by-Mail To pay by mail please send your payment to: The Sports Medicine Clinic P.O. Box 3541 Seattle, WA Please enclose the remittance portion (the bottom portion) of your monthly statement with your payment. Have questions about your bill? Contact us at (206) during office hours Monday - Friday, 7 a.m. - 5 p.m. Motor Vehicle Accidents If your medical care is the result of a motor vehicle accident, please provide us with your claim number and the name of your adjuster when you register. Ask your claims adjuster how much Personal Injury Protection (PIP) you have. After you have exhausted your PIP we will bill your medical insurance. If you do not have medical insurance, please call us at (206) to make financial arrangements. We will not bill the insurance company of other parties. 3

4 Workers Compensation If your visit is the result of a work-related accident or injury and your employer is insured through the Washington Department of Labor & Industries, we will provide you with the necessary forms when you register, otherwise please bring the paperwork your employer has given you. It is your responsibility to give us a valid claim number and the name and billing address of the company providing your workers compensation benefits. Patients with No Insurance The Sports Medicine Clinic provides a 20% discount to patients who agree to pay in full at time of service. To be eligible for this discount, you must pay your bill in cash or by debit or credit card before you leave the Clinic. If you are uninsured and cannot pay in cash or by debit or credit card, we will reschedule your visit. This discount does not apply to co-pays, deductibles or co-insurance. Patients who exceed their annual physical therapy limits It is your responsibility to monitor the number of your physical therapy visits and know how many visits your insurance will pay for. When you exceed the maximum number of physical therapy visits, you must pay for your PT visits at time of service. We will discount PT visits in excess of your visit maximum by 20% provided you pay for them on the day of your appointment. Patients whose insurance plans deny physical therapy visits Some insurance companies deny physical therapy visits as not medically necessary. We will appeal these denials for you, but you will be responsible for payment, less the 20% discount, until the denial has been overturned. What if I cannot pay my bill in full? If you are having trouble paying for all or some of your health care, we encourage you to talk with the Billing Department before service about how we may be able to help you. Financial Assistance The Sports Medicine Clinic coordinates financial assistance with Northwest Hospital & Medical Center. You must have been approved under Northwest Hospital s Charity Care Plan for your Northwest Hospital bills before you can receive financial assistance for your bills from The Sports Medicine Clinic. 4

5 Please call Northwest Hospital s Patient Financial Services at (206) to apply for financial assistance for your hospital bill, or download the form at After you have been approved for charity care by Northwest Hospital, please call the Billing Department at The Sports Medicine Clinic and ask for a reduction of your clinic bill. Payment Plans We are pleased to offer convenient payment plans for patients who cannot pay their bill in full. For more information, please call our Billing Department at (206) We waive interest charges for patients who make regular payments and pay their bill in full. Amount Owed and Months to Pay $ $ $501-1,000 $1,001-3,000 $3,001 & above 3 6 months 5 9 months 7 12 months months months It is important that you contact us to set up a payment plan. If you receive new services, you must call us to have them added to your payment plan. This may increase your monthly payment. Please call us when a payment is going to be late. If your monthly payments are more than 90 days overdue, we reserve the right to send your account to our collection agency. If you make monthly payments outside of a formal payment agreement and we consider your monthly payments too low in relation to the balance of your account, we will also assign your account to our collection agency. We do make exceptions to this policy on a case-by-case basis. Please call us to discuss. Frequently Asked Questions Q: How often will I receive a statement from The Sports Medicine Clinic? A: We send statements at the beginning of each month. Payment is due upon receipt. Q: How will I know how much I owe? A: Your health plan may require a co-pay or deductible due at the time of your visit. Please check with your insurance company to determine how much you will be responsible for. Following your visit, your insurance company will send you an Explanation of Benefits (EOB) describing the amount paid, any non-covered or denied amounts, and the remaining balance you are responsible for paying to The Sports Medicine Clinic. Please review your EOB, compare it to The Sports Medicine Clinic statement, and call your insurance company or our Billing Department if you have questions or concerns. 5

6 Q: Will you turn my account to a collection agency if I don t pay my bill? A: Yes. We send Final Notices to all patients with self pay or after-insurance balances over 90 days from the date we billed you, with the exception of patients making regular monthly payments on a pre-arranged payment plan. Patients have 15 days to pay their bill in full before we send their accounts to our collection agency. Patients whose accounts have been turned to our collection agency will have their care discontinued at The Sports Medicine Clinic. 6

7 Q: What do the Comments in the Description column on the monthly patient statement mean? Comment What it means Comment What it means Coverage terminated You are responsible for the full amount of the bill. Other insurance info The insurance company we billed has indicated you may have other insurance coverage. Please call us Deductible applied Incident report Insurance request info Max benefit expended Claim denied/mva Not eligible Not covered by plan No referral from PCP These charges were applied to your annual deductible. Your insurance will not pay until you return the incident form asking for details of your injury. If you do not return the form to your insurance within 30 days, you must pay the bill in full. Your insurance company is requesting further information from you before they will pay this bill. You are responsible for the remaining balance. Please provide other insurance information. The insurance company billed has indicated you had no coverage at the time of service. You are responsible for the bill. You are responsible for the outstanding charges. You need to obtain a referral from your primary care physician. Insurance denied Patient co-insurance PIP exhausted No routine coverage Not related to SPU Not covered by SPU Wait period not met with the information. You are responsible for the full amount of the bill. The balance is your responsibility. No further benefits are payable by your Motor Vehicle Insurance. We will bill your medical insurance if you have provided us with its name and your subscriber information. If you do not have medical insurance, please pay the full amount of the bill. Your policy does not cover routine services, you are responsible. Please provide other insurance coverage. Please provide other insurance coverage. Your policy has a waiting period that must be met before covering these services. You are responsible for the balance. 7