Insurance coverage is an agreement between you and your insurance company. To help you collect from your insurance, we will complete all your medical insurance claim forms and send them on your behalf so your insurance company can pay us directly. Any remaining balance that is not covered by your insurance is your responsibility. If you and your insurance pay us more than you owe, we will promptly send the overpayment back to you. Please be prepared to pay your co-payment, if any applies, at the time of your office visit. We accept cash, checks, Master Card or Visa.
Medicare:
Hand Surgery & Specialty Orthopaedic Centers do accept assignment on all Medicare Part B claims. This means we agree to adjust your charges to Medicare’s approved amount. Medicare will then send the payment directly to our office. Medicare reimburses 80% of the amount allowed after your Part B deductible has been met. The remaining 20%co-payment and deductible, if any, is your responsibility. For your convenience, we will bill one supplemental insurance carrier. If you do not have a supplemental insurance policy, any deductible and/or co-payment are your responsibility. We will send you a statement of your balance after we receive payment from Medicare. We appreciate all payments made in a prompt manner.
HMO’s and PPO’s:
If you are covered by an HMO or PPO, please be aware that each one has different insurance arrangements and claim procedures. Some require referrals, deductibles and co-payments which you are required to pay. Our staff will work with you to help you receive your full benefits.
Worker’s Compensation or Accident-Related Claims:
Hand Surgery & Specialty Orthopaedic Centers are not responsible for any disputed claims. When an accident, liability, worker’s compensation or group claim is disputed, the matter is resolved by the patient and the company involved. In such cases, the patient and the company may be requested to pay the bill prior to the claim being resolved.
In order to file your claim for worker’s compensation, auto accident, or personal liability, we must have written acknowledgement from the responsible party in advance for treatment and payment. Worker’s compensation patients must include both the employer’s and the insurance company’s names and addresses. Failure to bring a letter will result in your appointment being rescheduled.
If you elect to have surgery, you will be given notice of the fee in advance. It will be your responsibility to contact your insurance company and let them know of the surgery and the fee. You will be responsible for any balance not paid by your insurance. Minors must be accompanied by an adult.
Second Opinions:
Many insurance companies and employer-group plans require an approval (“pre-authorization” or “pre-certification”) before your doctor performs certain tests or admits you to the hospital. Your policy may also require a second opinion before your insurance company will agree to pay for certain surgical procedures. Please be aware of your insurance company’s or employer’s authorization requirements before your visit to our office.
Legal:
If your attorney needs reports or forms regarding your medical treatment, we will be happy to respond to his or her written request, but only with your signed approval. Depending on the request, some charges may need to be prepaid by either you or your attorney.
Important Reminder: Your attorney may have agreed to wait until your claim is settled before receiving payment for legal assistance. We do not provide medical care on that basis. Please feel free to talk to us if you have any questions regarding this matter.
