All professional fees for services rendered are within usual and customary guidelines. The type of insurance you have will determine whether payment is due at the time of service or can first be filed with your insurance. Your insurance may require preauthorization that may be your responsibility to obtain prior to treatment. Your copayment/co-insurance and deductible amounts will be due at the time of service. Payment may be made by cash, check, MasterCard, Visa or Discover.
We do not accept Medicare assignment. However we do follow the Medicare Fee Schedule. This means that payment for office based services is due at the time the service is rendered. Medicare will be filed by the office for patient reimbursement of covered services. Medicare hospital based services and hospital surgery can first be filed with Medicare. The patient will be responsible for any balance due.
Your insurance claim may be filed on paper or electronically. Statements are mailed monthly. Your prompt payment is appreciated. Past due amounts are subject to rebilling fees, collection and associated attorney fees.
How Doctor's Fees Are Determined?
Patient's often have questions as to why the amount charged by their physician may differ from a previous visit charge or why their neighbor was charged one fee and they get charged another.
Charges for Providers (physicians or suppliers of a medical service) are based on several different factors. These include the following
- whether you are a new patient (initial appointment or have not been seen by the Doctor within the last 3 years) or whether you are an established patient (follow up appointment or have seen the Doctor within the last 3 years)
- the Doctor is part of a managed care plan with a contracted network fee schedule
- whether you area a Medicare patient (age 65 or over, disabled or have met government guidelines to qualify)
- and the level of care and type of professional service rendered
There are 5 levels of care for both new and established patients as recognized by the AMA, HCFA (Health Care Financing Administration of the Federal Government) and the Current Procedural Terminology Code Guidelines for health insurance reimbursement.
Each level of care (referred to as Evaluation and Management) for each patient encounter is assigned a code and a usual and customary fee which Providers may or may not decide to follow. If a Provider belongs to a managed care plan, he must accept the contracted fee; if the Provider's fee is higher the balance will be adjusted and a network credit issued. Adjustments happen frequently because many managed care plans do not furnish a fee schedule to Providers.
The levels of care (Evaluation and Management) are based on 3 components
1. The type and extent of the medical history 2. The type and extent of physical exam 3. The level of medical decision making
What does all this mean? It means that the problem you are seeing the Doctor for may vary and he/she may need to evaluate and manage your condition at various levels of care depending on what you are being seen for and how you are progressing.