PATIENT FINANCIAL RESPONSIBILITIES
In order to accommodate the needs and
requests of our patients, we have enrolled in numerous managed care
insurance programs and participate with Medicare. We have contracts
with these insurance carriers, as you do with your carrier, which
obligates us both to certain requirements.
If you are enrolled in Medicare, we
are obligated by law to attempt to collect your co-insurance. Medicare
has a fee schedule that we must abide by. Medicare reimburses us 80%
of the allowed amount and expects you to pay the other 20%. You are
also expected to pay your deductible at the beginning of the year.
If you are enrolled in a managed care
plan, you are required to pay a co-payment at the time you receive
services. This amount varies by insurance plan and the type of service
you are receiving. As we are a specialty service, you must also be
referred to us by your primary care physician, who must provide us
with a referral number. Many of the plans also require that we obtain
a pre-certification number authorizing us to perform services other
than a normal office visit, such as chemotherapy, bone marrow biopsies,
and hospital services. If these referral and pre-certification numbers
are not obtained prior to providing services, no payment will me made.
Please assist us by requesting a referral number from your primary
care physician and ensuring that we have these numbers prior to your
visit. Be aware that there are also Medicare and Medicaid managed
care programs that also have these requirements.
If you have no insurance, it may be
possible to set up a payment plan.. Our Financial Coordinator, Katie V. would be happy to help you.
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MANAGED CARE INSURANCE INFORMATION AND RESPONSIBILITIES
Are the letters HMO, PPO, or
POS noted on your insurance card? What about PCP?
Better check, because if so, you are
part of the managed care world. Managed care means that your medical
insurance company may direct you to a specific doctor or doctor group
for the diagnosis and treatment of your condition. You, as well as
any doctor you see, are responsible for knowing and following the
guidelines of your managed care plan.
What are your responsibilities?
1. It is your responsibility to contact
your Primary Care Physician to obtain referrals for visits at our
office. All doctor and nurse visits need referrals, so be sure to
request an appropriate number to reflect your upcoming visits.
2. You should read your insurance benefits
book carefully. In it, you will find instructions on how to obtain
medical treatment in agreement with your insurance plan. Become familiar
with what services need prior approval from your Primary Care Physician
(PCP) or precertification from your insurance company.
3. If required by your insurance plan,
we will be happy to obtain prior approval for services ordered by
our doctors. However, we need your help to assure that these services
are properly approved by calling your insurance company before
the planned event.
4. Remember, if the managed care guidelines
are not followed, you, the patient will be held responsible for payment.
What is NEHO responsible for?
1. We will obtain proper approval for
any out-side services, such as hospitalization, home health services,
diagnostic testing/procedures (MRI, CT scans), surgery to name a few.
2. Your Primary Care Physician (PCP)
or referring doctor will be kept up-to-date on your condition and
progress by letters and doctors notes sent to them.
We hope this information is helpful
to all patients who have Managed Care. NEHO is committed to working
with you and your insurance company to provide you with quality, cost-effective
care! Thank you for being an active partner in your care.
