Why the Change?

There are several reasons for this change. With the changing environment in healthcare, in particular the Affordable Care Act and High Deductible Health Plans (HDHPs) more responsibility of payment is being placed on the patient. We need to be sure that patient balances are paid in a timely manner. To do this, we need to ensure we have guarantee of payment on file in our office.

What is a Deductible and how does it affect me?

An annual deductible is the dollar amount you must pay out of pocket during the year for medical expenses before your insurance coverage begins to pay. For example, if your policy has a $2000.00 deductible, you must pay the first $2000.00 of all medical expenses before your insurance company begins to pay for any services.

When does a deductible begin?

Your deductible begins at the start of your plan year. Most plans begin on January 1 or July 1 but plans can start on any date. You will need to check with your insurance company to find out the start date if you do not know.

When do I have to pay for services?

Any time you receive medical care, you will be expected to pay in full for your services until your deductible is met. If you have a very large deductible, called a high-deductible insurance plan, you may have to pay out of pocket for most of your primary care services.

How will I know when my deductible has been met?

You can call your insurance company at any time to check on how much of your deductible has been met and some insurance companies have this information available online. Every time you receive medical services, you will receive notification from your insurance company with how much they paid or did not pay if the amount went to your deductible when they send you an Explanation of Benefits (EOB.)

But I always pay my bills, why me?

We have to be fair and apply the policy to all patients. We have wonderful patients and we know that most of you pay your balances. Unfortunately, this is not always the case.

Do I need to sign a new financial policy?

No. The financial policy you sign when you enrolled with our practice already allows for this change: “Payment for all services is my responsibility and is due and payable at the time of services are rendered.”

How will I know how much you are going to charge me?

You will receive a letter in the mail from your insurance carrier that explains how much of your office visit they pay and how much you pay. This is called an Explanation of Benefits (EOB.) This letter tells you exactly, according to your health insurance coverage, how much of your health care bill is your responsibility and how much responsibility of your insurance to pay.

Then What?

We receive the same Explanation of Benefits that you do. Most insurance companies will send you EOB prior to us receiving our copy. It arrives about 10-20 days after your appointment has been billed. We look at each EOB carefully and determine what your insurance has determined as the patient responsibility. This is the same way we normally determine how much to send you a statement for in the mail.

Will you send me a bill to let me know what I owe?

All patients with commercial insurance are required to keep a credit card or debit card on file. If you do not wish to keep a card on file, we will expect an estimated payment at the time of service. For example, if your commercial insurance requires $150.00 to be paid for standard service and your deductible is not met, you will be expected to pay $150.00 via check or cash before you are seen, but this will not include ancillary charges that may arise out of your visit. Once we receive the EOB on your visit we will send a statement if your patient responsibility is higher than the originally collected amount or you will have a credit on your account if your patient responsibility is lower than the originally collect amount.

But wait, I’m nervous about leaving my card on file.

We do not store your sensitive credit card information in our office. We store it on a secure website called a gateway. The gateway we use is called Advanced MD. Advanced MD is PCI-DSS compliant and is certified by VISA.
This gateway is only used to process your payment and email you a receipt once payment is processed.

What is PCI-DSS?

Payment Card Industry (PCI) Security Standards Council offers robust and comprehensive standards to enhance payment card data security and reduce exposure to credit card fraud. PCI Data Security Standard (DSS) provides an actionable framework for developing a robust payment card data security process, including prevention, detection, and appropriate reaction to security incidents.

When do I give you my credit card?

We prefer for you to fill out the Credit Card Authorization Form and provide us your credit card in person. We will swipe your credit card with an encrypted reader that will securely upload your credit card number into the Advanced MD gateway and return the card to you. With the encrypted reader, we will never see all the numbers of your credit card. You can deliver your credit card information over the phone or by mail, but the most secure way is in person through the encrypted reader.

My High-Deductible Health Plan has a Health Savings Account (HSA) Card. Can I keep my HAS card on file?

Yes, you can keep your HSA card on file, however, we may require an additional card to be kept on file should the funds in your HSA account become insufficient.

What if I need to dispute my bill?

We will always work with you to understand if there has been a mistake. We will refund your credit card if we or if your insurance company has made a billing error. We will only charge the amount that we are instructed to by your insurance carrier, in the EOB they send to us, in the same way that we normally determine how much to send you a bill for in the mail.

What if I have more questions?

Our staff is happy to speak with you about your account at any time.