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| Insurance |
We accept all major commercial insurance carriers and governmental carriers such as Medicare, Medicaid, and Tricare. It is highly recommended that you check with your insurance company/plan before coming to your appointment to verify our physicians are providers for your plan. Generally, you can find a list of providers on the website of your insurance company, insurance handbook, or talk to your employer personnel department. If not, call the insurance company to see if our provider is on the physician panel. The patient is responsible for keeping track of the referrals and should know when the referral expires. You are responsible for contacting the Primary Care Physician for a new referral prior to the next visit. Many insurance companies send notification to the patient confirming the dates of coverage and how many visits are allowed. You can call our office to see if any visits remain or if the referral is nearing the expiration date, but we are not responsible for getting the referral for you. You must call the primary care physician. You are responsible for making sure the referral has been sent to our office or bring the referral with you when you come for the appointment. Yes, we verify benefits and coverage, however there is no guarantee the information given to us by your insurance company is correct. We receive a quote or estimate of your benefits from the insurance company. This is not a guarantee of coverage or payment. The quote comes with a disclaimer that the benefits as quoted may not be accurate or that the insurance company will pay the claim. There is no guarantee of payment until the claim is received by the company and a review of benefits is evaluated. There are several factors that are considered before payment is made such as pre-existing conditions, deductibles, coverage under the contract with the employer, and co-payments. We strongly suggest that you contact your insurance company and verify the benefits as well. The patient is responsible for payment of services received if the insurance company does not pay the claim. We are not a party to the contract between you, the employer, and the insurance company. Our physicians provide a service, file the claim as a courtesy to our patients, and expect to be paid as any other service provider would expect to be paid. We will not get involved in disputes with the insurance company, but we will provide information to the insurance company on your behalf to assist you in getting your claim paid. In the interim period of dispute the patient should pay the balance to clear the account. Should the insurance company pay us after you paid the balance we will refund the payment to you.The employer is the best resource for help in claim disputes. Call the office and we will give you an estimate of charges. Remember, this is only an estimate and will depend upon the symptoms and the tests performed to diagnose those symptoms. The cost could be more or it could be less depending on which tests are performed. No, we can not bill you according to the terms of our contract with the insurance company. Providers may have a contract with the same insurance company as the patient but our contract is separate from the one the patient and their employer have with the insurance company. We are required by our contract to collect the co-payment in full at the time of service. Our insurance contract does not allow us to waive the co-payment. If we do not comply with the terms of our contract the insurance company can cancelled the contract for non compliance. Each year the patient receives a new card from their insurance company. The co-payment amount will be shown on the card. It is your responsibility to know how much you must pay as a co-payment and to make sure you have the most current card in your possession when you visit the office. If the amount you pay is based on a co-payment from an old card and the amount of the co-payment on the new card is higher you will be responsible for the difference between the old co-payment and the new co-payment. Insurance companies send the patient an Explanation of Benefit statement detailing the reasons for payment or non-payment of the claim. Generally, the patient receives the statement showing the claim has been paid before the actual payment is made to the physician's office. Call the office to see if payment has been received. |
 | © 2009 Allergy & Asthma Center, PA |