NOTICE OF FINANCIAL POLICY MIDWEST DERMATOLOGY CLINIC, P.C.
Midwest Dermatology Clinic has a friendly, professional staff of customer service representatives eager to help with your insurance claims. In many cases, we are required to file your claim to the insurance carrier and work directly with them to ensure proper payment. We need your cooperation to ensure that your claim is filed correctly. Please read over the following information at this time. It will assist us in working together. If you have any questions, please contact our customer service representatives by calling our main phone at (402) 552-2555.
BEFORE YOU ARE SEEN
If you are a member of a managed care plan (a plan which limits your providers, such as an HMO or PPO), please check your most recent provider directory to determine whether our physicians are members of your plan. If you see a doctor who is not listed on your plan, you may have to pay higher co-pays and/or deductibles. In some cases, insurance carriers will not pay at all when a patient sees a doctor outside of the plan. It is your responsibility to determine what type of coverage you have when you visit our office and you will be required to pay for the difference if we are not providers in your plan. If your managed care plan required a referral from a primary care doctor (usually an HMO), please bring the referral with you on the day of your appointment. Without a proper referral, payment may be refused by your insurance carrier and it would be your responsibility to pay the entire cost of the visit. Patients may be asked to reschedule if a proper referral is not provided. We must have current information concerning your insurance carrier in order to file your claim successfully. If we do not have the correct information, payment of your claim will be delayed. If we do not receive the correct information within time limits imposed by some insurance carriers, your claim may be denied by the carrier and the obligation for paying the bill would be yours. Please present a current insurance card complete with the address and phone number of your carrier to our receptionist at each visit. A photocopy of your card will be forwarded to our insurance department to assist in filing your claim.
AT THE OFFICE
On the day of your visit, we will collect all co-pays (usually printed on your insurance card), known deductibles and outstanding balances before you are seen by a Midwest Dermatology Clinic physician.If your insurance card does not specify your co-pay amount, but states that co-pays may apply, it is our policy to collect $50.00. In addition, we will collect payment in full on the date of service for all cosmetic procedures and services your insurance company does not cover. Patients with delinquent accounts may be asked to reschedule if they do not pay their account in full on the date of service. If you are not covered by any health insurance plan, we will ask for payment in full at the time of service. For your convenience, we accept MasterCard and Visa, Discover and American Express.
Return check fee is $25.00
FILING YOUR CLAIM
Midwest Dermatology Clinic participates in most managed care plans. As a provider in these plans, we are required to file claims for their patients and are paid directly by the carrier. If you are covered by this type of plan, we will not bill you for any uncovered charges until your insurance carrier has determined that it has paid in accordance with your policy. This process takes time and you may not receive a bill until two or three months after the date of service. Your statement will indicate the portion of your bill which is still pending with your insurance carrier and the portion due by the patient. We ask that you pay the patient portion of your statement in full when it is received. As a courtesy, we also file claims for patients who are covered by private health insurance plans. Patients covered by private insurance plans will be billed monthly and must make regular payments in order to keep their accounts current. Patients who receive payment from their insurance carrier are obligated to forward payment in full to our office at that time. If an account is not paid within 90 days of receiving your first bill, Midwest Dermatology Clinic may turn your account over to a collection agency. Patients with accounts which have been turned over to a collection agency will be asked to pay their account balance in full prior to seeing any physician in our practice and may be required to pay cash at the time of visit for all future appointments.
Failure to provide accurate insurance information will result in the patient or guarantor being responsible for the bill in full.
If an account is not paid within 75 days of receiving your first bill, Midwest Dermatology Clinic may turn your account over to a collection agency. When an account is sent to collections, Midwest Dermatology Clinic may add a surcharge to the account balance. Patients who’s accounts have been turned over to a collection agency will be asked to pay their account balance in full prior to seeing any physician in our practice and will be required to prepay at the time of visit for all future appointments.
PATHOLOGY AND LAB FEES
If your visit includes biopsies or lab tests, these specimens could be sent to an outside lab for processing. You will receive a separate bill from the laboratory performing the services. You are responsible to notify us if your insurance company requires that we send your specimens to a particular lab in order for your insurance to cover it.
KEEPING IT CONFIDENTIAL
Midwest Dermatology Clinic, P.C. maintains patient information concerning medical records and insurance in the strictest of confidence. You will be asked to sign a release which allows us to share needed relevant medical information with your insurance carrier. Your signature also allows us to provide medical information to your physician and insurance company. Information will not be shared with any other party without prior written authorization from you (except when required by law). Thank you for choosing Midwest Dermatology Clinic, P.C. as your provider of dermatology care.
BILLING AND INSURANCE QUESTIONS
Questions regarding your account are handled by our Patient Account Representatives. Please feel free to contact your representative as indicated by the first letter of your last name: A – K: (402) 552-2564 L – Z: (402) 552-2579