How Your Insurance Plan Works

• As a participating member of your insurance plan, we agree to accept, as payment in full, a discounted rate. After the insurance payment we adjust off an amount, which makes the difference the discounted rate. You are responsible to pay for this remainder.
   
• You received a letter from your insurance company asking for more information, but apparently they never received a response. They are waiting to pay the claim until this information is received back. This happens when the insurance thinks there is another insurance involved. Examples of this are accidents, traumas and families where both father and mother have health insurance. Call the insurance company immediately so they will release the money on your claim. We will make our adjustments and settle the claim.
   
• The insurance company says you do not have coverage. Do not ignore this one, especially if you know you have coverage. You need to respond to us immediately since we may be billing the wrong company. This is the main reason we ask you to bring a copy of your insurance card with each visit. Just because you continue to have the “same” plan such as Blue Cross, doesn’t mean the billing addresses on the back of the card continues to be the same. There is Blue Cross of California, Florida and so on. 
   
• You have no hospital or office coverage for our services. There are many variations of insurance plans. Some cover vaccinations and some do not. Others put a limit on the number of visits you may have and others limit certain visits by your age. You or your employer picked this plan and you need to either read the plan or call the company to see if they pay for the service. If they do not, they may have an adjusted rate that you are entitled to. You are responsible to pay for the service.
   
• Your insurance paid a portion of the services and then paid us. We will adjust off the amount that brings the bill to the contracted rate for the service. You owe the remainder. This can happen even if you have a co-pay. Each insurance company has many plans that pay differing amounts for this share of costs. You have to read the fine print. 
   
• When you purchase an insurance plan there is often a “deductible”. This is the amount you must pay before the plan starts to pay. “Balance applied to Deductible” means just that.  You are responsible to pay for the amount until you reach the amount that is in your health plan contract.
   
• Vaccines are not covered or are only partially covered under your insurance plan. Each of the major insurance companies has different plans that pay differently for vaccines. Whether they pay for them or not, we feel they are a mandatory part of the early visits. You are responsible to pay for the vaccines.
   
• Your plan did not cover additional screening services such as a hematocrit, visual exam, hearing exam or urinalysis. They may, however, have a lower rate for the service. We will adjust this amount when they deny payment. You are responsible to pay for the screening service.
   
• The bank did not pay your check or there were not enough funds to pay the bill (bounced). We do not re-submit the check, so you need to reissue a check. There is an additional charge for this transaction.
   
• Co-pays are due at the time of service. These cannot be discounted. Your insurance company requires that you pay this amount. There is an additional charge for missed co-pays.
   
• We require a 24-hour notice if you cannot keep an appointment. We can usually fill in the appointment time if we have sufficient notice. There is a charge for a missed appointment. 
   
• We must collect payment for any prepackaged medicines that we sell to you from the office. We had to prepay for these so there can be no exceptions. Please pay immediately so that we can continue this service for you.