And Patient Responsibility
We are committed to providing you with excellent patient care in an ever-changing managed care environment. We encourage you to coordinate as completely with your insurance company as possible, to make sure you thoroughly understand which costs your insurance company will pick up, and which costs you are responsible for.
Please note that it is ultimately your responsibility to know your policy’s benefits and limitations; your policy is a private contract between you and your insurance company, and our physicians are not involved with establishing the terms of the contract. Charges for our services that are not covered by your insurance company will be transferred to you.
If we are not providers under your plan, you are required to pay in full at the time of service. We are happy to file a claim with your insurance provider should this be the case, and will reimburse you any benefits paid to us.
Well-woman (annual) exams – which include a breast and pelvic examination and a PAP smear – are considered preventative care, and may not be covered by your insurance company. You should check specifically with your insurance company if well-woman exams are covered by your plan before scheduling one; if they’re not, you should be prepared to pay for the exam on the day of your appointment.
Here are some suggestions to help you coordinate with your insurance company and to help you know what costs you’ll be responsible for before your appointment:
- Confirm that the physician you’re seeing is in network as a contracted provider under your insurance plan, by calling the phone number on the back of your insurance card for members.
- If you belong to an HMO, verify with your insurance company that the primary care provider you have on file does not inhibit your ability to directly access our physicians without a referral.
- Don’t rely on provider directories or our office staff to confirm participation; make sure you confirm directly with a representative from your insurance company.
- Bring your current insurance ID card with you to each office visit – you will be asked to present proof of coverage with each visit, and failure to provide proof of coverage may require payment in full at the time of service, and with each following visit until we receive the necessary information to file your claim.
Preventative Care Benefits
Here is information from the healthcare.gov site on preventative care benefits, which apply to you if you purchased insurance through the Affordable Care Act’s Marketplace through healthcare.gov (and may be part of your insurance plan if you secured insurance without using healthcare.gov.
For any specific questions you might have about payments and service costs, appointments, or for updating insurance information and plan changes, we have a number of staff members ready to answer at 713.365.2917.