| If you have: |
You are responsible for: |
As a courtesy to you, our staff will: |
| An HMO (Including Medicare HMOs) with
whom we are contracted |
1) Obtaining a referral from your primary care
physician
2) Payment of Co-pays and Deductibles at the
time of service
|
File an insurance claim on your behalf |
| An HMO with whom we are not contracted |
Understanding your co-pay responsibility |
File an insurance claim on your behalf |
| Point of Service (POS), Preferred Provider
Organization (PPO) Plan, or Indemnity Plan
with whom we are contracted |
1) Obtaining a referral from your primary care
physician (if applicable)
2) Payment of the patient responsibility at the
time of service
|
File an insurance claim on your behalf |
| Commercial, PPO, or any Plans with whom we
are not contracted |
Payment of the patient responsibility at the time
of service based on out of network benefits.
Many insurance companies base their payment
on “usual and customary charges.” The patient
may be responsible for any amount above
“usual and customary.” |
File an insurance claim on your behalf |
| Medicare without secondary “Medigap” policy |
Payment in full of deductible and 20%
coinsurance at time of service |
File a Medicare claim on your behalf |
| Medicare with secondary policy |
Payment of remaining deductible and
coinsurance |
File a Medicare claim on your behalf, file a
secondary insurance claim |
| Secondary Insurance |
Supply policy information, and pay coinsurance
and deductible amounts |
File secondary insurance claims on your behalf |
| No Insurance |
Payment in full prior to service |
We offer a discount from standard fees. |
| Workers Compensation |
Provide us with the accident date, claim
number, attending physician, employer,
employer’s address and adjuster information. |
File an insurance claim on your behalf |
| Accident Related (non Workers’
Compensation), PIP, or LOP |
Providing correct information regarding
accident, attorney and legal case. |
File claims to your attorney or other responsible
party. |