Important information for new patients:

What is the difference between an HMO and a PPO?

HMO members must choose a primary care physician (PCP) from among the HMO member physicians. The PCP provides general medical care and must be consulted before you can see a specialist, who must also be a part of the HMO. PPO members do not choose a primary care physician and can refer themselves to a specialist.

HMO's typically provide no coverage for care received from non-network physicians (with exception to emergency care while traveling, etc). PPO members are not required to stay within the PPO network, but there is usually a strong incentive to do so. For example, the network may reimburse 90 percent of costs for care received within the network, but only 70 percent of costs for non-network cases.

HMO's typically do not set deductions that must be met before insurance benefits begin (e.g. $5 or $10). Instead, HMO members often pay a nominal co-payment for care. In contrast, PPO's sometimes require members to meet a deductible and may have larger co-payments than HMO's.

* Please take note *

We participate in most of the insurance plans available in this area. We directly bill your insurance company for the services you have received from our providers. Our medical practice usually accepts what is paid by your insurance company for services rendered to you. In addition to this, however, there are additional charges that you are responsible for. These include co-pays, deductibles, and charges for services that are not covered under your insurance policy. Payment of these is mandated by Federal and State law, and/or by insurance carrier policy and/or your contract with that carrier. You are responsible for any deductibles and the co-pays required by your insurance plan. Federal law prohibits medical practices from directly waiving co-pay's in Federal entitlement programs such as Medicare. Federal law allows a patient to obtain a waiver if the patient sends a signed, written letter to the medical practice stating financial hardship justifying a waiver.

Here are some terms you may have heard before concerning insurance:

1. Deductible - a set amount of medical expenses you have to pay before the insurance company begins to pay. This amount may vary from $100 to $5000 and ususally begins at the first of the year.

2. Co-Pay - this is the amount your insurance company says you have to pay at the time of your visit or you will not be seen.

3. Primary Insurance - the main insurance company you have.

4. Secondary Insurance - your "back-up insurance".

* Please notify the office of any change in your insurance information, i.e. change of company, ID number, etc.

* If the insurance company pays YOU for the medical care you received, you are responsible for paying us!

Billing

We bill the insurance companies for you, both your primary and your secondary insurance. Usually, it takes the insurance companies 30 to 60 days to respond to our billing office once a claim has been submitted. Then, if further information is needed by the insurance company, it may be another 30 to 60 days before we hear from them, especailly in the case of Medicare and Medicaid.

We communicate with the insurance companies on a regular basis to get payment from them for your medical care. As you can see, this process can take many months, perhaps a year or more. This is why on occasion, you may receive a bill from us for services rendered 12 to 18 months ago.

Payment Plan

We do accept payment plans from our patients.

Insurance Forms

PLEASE FILL OUT ANY FORMS YOU RECEIVE FROM THE INSURANCE COMPANY! Many times, the insurance company will not pay if forms have not been completed and sent back to them.

Referrals

Your insurance company may require that you have a referral so that you may be seen by our doctors. If that is the case and you do not get a referral from your doctor, you will be responsible for the bill.

Litigation

If you are involved in legal action and have an attorney, we ask that you sign a form called "Assignment of Benefits". This is an agreement between this office and you that we will withold billing you until your case has been settled. At the time of settlement, payment in full on your account is expected.

Collections

In the event that the insurance company has denied your bill and we have billed you and no payment has been made, it may become necessary to seek further action. At that time, you will receive a letter from the Billing Office alerting you that you will be sent to Collections unless you contact us. Once a case is sent to the collection agency, it is out of our hands.

Questions

If you have any questions about your bill, please contact our Billing Office at (540) 801-8804. They are ready and willing to help you with questions regarding your bill. They are available Monday through Friday, 8 am to 4:30 pm.