 Managed Care places specific
responsibilities on Physicians and Patients. These responsibilities are
spelled out in the contract with the insurance carrier. Understanding your
role will help facilitate referrals and financial matters. We hope you
will take a few minutes to familiarize yourself with our Office Policy regarding
finances and referrals.
Referral Policy
It is the patients responsibility to ensure that a
valid referral is on file for the services being rendered. Referrals
are usually good for 30 to 60 days depending on the carrier and in the cases of
Allergy shots, some carriers will allow a global referral (up to 1 year).
Please be courteous to the Primary Care Physicians (PCP)
and request the referral early as some of the offices require 3 to 7 days of
advance notice. The patient may need to pick up the original referral from
the PCP, however, in some cases, the PCP is willing to fax the referral to our
office. We do accept faxed referrals.
Financial Policy
- Office charges are due and payable at the time of
service. Our Billing Office is to help facilitate insurance claims and
questions you may have. Accounts past 30 days old are considered delinquent
and those at 90 days will be referred to a collection agency for action.
- Professional services are rendered to the patient not
an insurance company. Since every insurance plan is different, please
be sure to check your coverage and ask questions before services are
rendered. We are here to help in any way we can.
- Your insurance can deny payment for services or
procedures after they are performed. We advise that you know the
benefits of your individual plan.
- Payment may be made by cash, check, Visa, MasterCard,
American Express, Discover, and Care
Credit.
- The office participates in
a variety of health insurance programs. If you are a participant in an
insurance program that we accept, you are expected to pay your co-payment at each visit.
Failure to do so can result in action by your insurance carrier.
Managed Care patients are liable for co-payments, per their carrier, and for
appointments not canceled in advance.
- The Billing Office files claims for all carriers with
whom
we participate. Payments by the insurance carriers will be made
directly to our office. They will provide you with an Explanation of
Benefits (EOB) of the charges, amount covered by your policy, and payments
made to our office on your behalf. Your insurance may or may not allow
a portion of your bill, the remaining balance is your responsibility.
If you have a secondary plan, as a courtesy, the billing office will submit
the primary payment information to the secondary carrier.
- The Billing Office submits all Medicare claims for you.
We also provide Medicare with your secondary insurance information.
Through their crossover program, your secondary insurance will be billed
directly by Medicare. Please check to see if your secondary insurance
requires a signed waiver in order for this to happen. Our office will
bill insurances not included in the crossover program. You are
responsible for yearly deductibles, non-covered services, and co-payments
when there is no secondary insurance.
- As a courtesy, the Billing Office also files claims to
carriers with whom we do not participate. Payments by the insurance
carriers may be sent directly to the patient instead of our office.
It
is the responsibility of the patient to remit payment to our office at the
time of service in these
cases. If you have a secondary plan, as a courtesy, the billing office
will submit the primary payment information to the secondary carrier.
- Workman's Compensation is filed as a courtesy to our
patients. However, if a claim is denied, unsettled or unpaid within 60
days, we request that you file a personal claim and pay the bill in full.
In all legal matters you are responsible for payment.
- Special consideration will be given to patients
financially unable to pay in full at the time of service. Arrangements
should be made in advance with the Billing Office.
- As pursuant to Virginia Law (VA Code 8.01-413) fees for
copying a Medical Record are: a search and handling fee of $15, plus $
.50 per page up to 50 pages, plus $ .25 per page for each page over 50.
Example: A 62 page chart; $15 (Handling) + $25 (50 pages x 50¢) + $3 (12
pages x 25¢) = $43.00
Electronic medical records can be burned to a
DVD or CD. The charge for this is $20.
- There will be a $30.00 charge for all returned checks.
Thank you for choosing Metropolitan ENT
as your Healthcare Provider.
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