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Financial Matters
PATIENT ACCOUNTS
Insurance Procedures
We are eager to
offer assistance in processing insurance claims as a courtesy
to our patients. In order to do so, you must provide complete
and correct insurance information to avoid delays in payment. Claims
are filed within two working days from the date of service at
no additional cost to you.
If you are a member of an HMO, POS or PPO we request that you
or your designated family, friend, or contact know and follow
the rules and regulations of your carrier. We participate
with most major insurance carriers; however, the industry is
changing and your coverage may change as well. On your
first visit you will meet with one of our Financial Coordinators
who will review your insurance benefits as it pertains to your
oncology/hematology care.
You will need to have the following documents:
• Referrals
• Authorization
forms
• Co-payments
• Insurance
card(s)
It is also your responsibility to have the following at the
time of each visit:
• All
necessary authorization forms
• Co-payments
• Insurance
card(s)
Also, let our office staff know if your insurance requires pre-certification
for hospital admission or any other procedure. This information
would be indicated on your insurance card or in your handbook. If
it is not, call your insurance carrier. We have a Referral
Coordinator who will assist you in obtaining most authorizations
and/or pre-certifications except in cases of weekend or emergency
hospital admissions. You will be responsible for notification
to your carrier in those cases. Please be aware pre-certification
cannot be handled after the fact.
Situations usually requiring pre-certifications are:
• Admissions
• Scans
• MRI’s
• Home health
care
• Injections
and some chemotherapies
• Some outpatient
services
You will be required to pay for any denied charges as a result
of your failure to oversee your coverage.
Medicare
If your carrier is Medicare Part B we will complete and submit all forms on your
behalf.
We are participating physicians and accept their
allowed amount for our services. They will then only pay 80%
of what they allow after you have met a calendar year deductible.
You are responsible for the remaining co-insurance. Our Financial
Coordinators will be happy to help you with any information regarding
Medicare.
The Centers for Medicare and Medicaid Services
(CMS) requires that all lab work be billed to Medicare only. You
will not be responsible for any amount that Medicare does not
pay on medically necessary lab work that is ordered by the physician. They
will send you an Explanation of Benefits that identifies the
service as Diagnostic Lab. You will be responsible for
any lab work Medicare determines is not medically necessary.
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Secondary Insurance
As a courtesy,
we will file to your secondary insurance after the primary carrier
has paid, assuming we have all the necessary information at the
time of service. If we do not have that information, you
will be responsible for the balance due.
Due to the constantly changing status of all insurance, Medicare
and Medicaid plans, our participation is always subject to change
and current participation is not a guarantee of continued acceptance
of these plans. For this reason, any change in your plan must
be discussed with your Financial Coordinator.
Fees
Professional Fees
Our professional
fees for your visits are based on the services you are given
before you arrive, during your visit and after you leave. These
services include one or more of the following:
• review
of pertinent x-rays and diagnostic tests
• review of
pathology slides with the pathologist
• phone consultations
with other experts in the
treatment of your condition
• discussion
of your care with the referring physician
• physical
exam and discussion with you and
your family
• coordination
of treatment plan
• dictation
of the medical record
• responding
to phone calls from you and your
family members
• specialized
nursing care required to administer
IV chemotherapy and biological therapies
• nursing
advice and support throughout
your treatment
• coordination
of appointments, outpatient
diagnostic tests and procedures, authorizations,
and hospital admissions
Your Responsibility
Due to the extensive
details required by insurance carriers and employer groups, there
is a fee for all forms completed by our staff other than insurance
claims for hospital, office, laboratory and chemotherapy visits.
In addition there are fees for the following:
• Co-payments
not paid at time of service
• Cancelled
appointment without 24 hour notification
• Medical
Records requested by third parties
Your Privacy
Release of Medical Information
We respect
your right to confidentiality. We are compliant with all
local, state and federal regulations pertaining to your privacy.
Should another physician or facility that is treating you request
records, we will honor that request. Any other party that is
not within the treatment, payment or operations of your care
who requests your information will need to have your written
approval to obtain it.
Your medical record is strictly confidential
and will not be disclosed to anyone outside of your treatment without your written
authorization, except where required by law.
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