Updated Financial and Payment Policies for 2015

Due to the increasing number of patients who now have “high deductible”  healthcare plans (HDHP), which allow the usage of health savings accounts (HSA) or medical savings accounts (MSA), we have changed our financial policies, effective January 1, 2015.

For calendar year 2015, the Internal Revenue Service has set the maximal individual HDHP deductible plus coinsurance annual out-of-pocket amount at $6450, and the maximal family HDHP deductible plus coinsurance annual out-of-pocket amount at $12,900.  This is the maximal potential amount which you are required to pay out of pocket to your health care providers until you have met your maximal annual out-of-pocket amount, after which her health plan pays us directly, with no out of pocket cost to you.

These payments may be made from your HSA or MSA accounts, using the debit card or checks associated with those accounts, or you may pain by cash, credit or debit card, or check.

It is the responsibility of the patient to ensure that adequate deposits to these HSA or MSA accounts have been made to cover the cost of medical care, and for the calendar year 2015 the Internal Revenue Service has set the maximum annual allowable deposit amount at $3350 for individual plans, and $6650 for family plans.

For all patients with HDHP policies, you will be required to make a payment consistent with the expected health plan allowance for the service which we provide, at the time of each visit, until your annual personal or family out-of-pocket deductible for the calendar year 2015 has been met.

We will calculate the expected health plan allowance for the service we provide based on the current calendar year Medicare allowance for that service, which is typically lower than your insurance plan allowance for that service, and any balance due to our office once your insurance plan has processed your claim will be collected at the time of your next visit.

You will be informed by our office in advance of your initial or follow up visit of the amount which will be required to paid at the time of your visit, which will be collected by our receptionist prior to the doctor seeing you for your visit.  The charges for diagnostic or procedural visits may be in excess of $500, and if you are not willing or able to make the required payment of the time of the visit, we reserve the right to cancel your visit until your account is paid in full with a zero patient balance due.

Our staff will be able to go online to your insurance carrier’s website to verify if you have a HDHP, and can also determine your total annual deductible, and the remaining patient balance due toward meeting your annual out-of-pocket deductible, at the time of any visit.

Please be aware of the fact that if you or other family members are being treated by other doctors, the charges for those visits submitted by other doctors offices may not be currently updated on your insurance company’s website, and therefore these amounts may not always be the most accurate, and may require you as a subscriber to call your insurance plan directly to obtain the most current patient balance due.

Please note that these policies only apply to patients with HDHP policies, and do not apply to patients with Medicare, Worker’s Compensation, or No Fault coverage, or patients with other insurance policies which do not include HDHP plans.

However, Medicare beneficiaries who do not have secondary Part B (non-hospital) coverage will be required to pay their 20% coinsurance and/or annual deductible amount at the time of service.

For all patients, regardless of whether you have a HDHP or not, we will continue to bill your insurance carrier directly at the time of each visit, but only if you sign the Assignment of Benefits waiver statement on the Phreesia Pad when you first register as a patient with our practice, which directs your insurance carrier to either allow us to bill them and collect payment from you directly until your annual out of pocket deductible has been met, or to pay our practice directly for the medical services which we provide to you.

If you refuse to sign the Assignment of Benefits waiver statement for any reason, regardless of your insurance coverage, or if you decide to revoke it at any time, payment for any and all office visits and other diagnostic studies or therapeutic procedures will be required to be paid in full at the time of each visit, and our office retains the right to discharge or deny service to any patient who refuses financial responsibility.

If applicable to your insurance plan, we are contractually obligated to collect a co-payment at the time of each visit, the amount of which is noted on your insurance card, and/or a co-insurance payment, which is the amount which your insurance plan holds you responsible for after the plan pays it’s contracted amount, often in the range of 20% of the approved fee for the visit.

If you are a self-pay patient, which means that you plan to pay without the use of insurance coverage, or if you do not have your insurance card at the time of registration and we cannot verify coverage with a referring provider and/or your insurance carrier, we will require a minimum payment of $200.00 towards your initial visit, and additional fees may be assessed at the time of check-out.

Payment of all co-pay and self-pay fees is collected at the time of check-in for each visit, prior to seeing the doctor.

We accept cash, check, all major credit cards and debit cards.

Your account will be charged a returned check fee of $35 for any personal check which does not clear our bank upon deposit, plus the original amount due. No future visits will be scheduled for any patient who attempts to pay our office with a “bounced check” or with an invalid credit card.

Insurance Plans

We participate in most local major plans including NYS Motor Vehicle No Fault, NYS Worker’s Compensation, and Medicare.

We do not participate in Medicaid, and we are unable to accept patients with this insurance as their primary or secondary coverage.

It is the sole responsibility of the patient to determine, in advance of their visit, whether our practice is a participating provider or an in network provider with their own insurance plan. Our office does not have any control over the terms of your contract with your insurance plan, but we are legally required to follow the terms of our contract with your insurance plan.

Workers’ Compensation and No Fault

It is our strict policy that no patient will be seen under these types of coverage until after we have contacted the insurance adjustor assigned to your claim, and have verified that there is a valid claim in existence, that adequate medical benefit coverage for medical treatment exists, and which body part(s) is/are covered under the claim. Under no circumstance will we bill for treatment for any non-covered body parts or conditions, nor will we bill the insurance carrier when claims have been closed due to denials of coverage or after financial settlements have already been made.

For patients with valid NYS Motor Vehicle No Fault or Workers’ Compensation claims, you will not be billed directly for any medical services provided, but you will be required to sign both our own Assignment of Benefits waiver form and any other required forms provided to us by the NYS Department of Financial Services (NF-3) or the NYS Workers’ Compensation Board (A-9), respectively, which permits us to bill either your private insurance plan, or you directly, but only if your claim is denied or disallowed at any time.

If you refuse to sign either our Assignment of Benefits waiver form (which directs the insurance company to pay our practice directly for your treatment) and/or the applicable NYS issued form (which permits us to bill your private insurance plan or you if your claim is denied or disallowed), we may refuse to provide you with treatment, even if there is a valid claim at the time of the initial visit.

If there are any adverse claims actions existing or a controverted claim pending without final resolution which would prevent us providing medical care or being paid for such care, we may refuse to provide care under these circumstances. With a written denial of coverage from the insurance carrier, you may be entitled to treatment under your private insurance coverage. Please check with your private insurance carrier directly regarding their policies regarding this issue.

Collection Policies

Our practice provides medical services to you, the patient, and not the insurance company. You are ultimately responsible for any outstanding balance on your account.

Any patient account balance which is outstanding more than thirty (30) days is considered delinquent. If your account balance is not paid in full within sixty (60) days, delinquent balances will incur a $25 late payment fee and may also be subject to interest charges of 1.5% per month, starting from the date the charges were first incurred.

Any delinquent patient accounts for which we feel that there has been no reasonable effort to settle the full balance due will be turned over to our collections department for further legal action. This can include reporting your delinquent account to all of the major credit bureaus, filing for summary judgement at the Onondaga County Courthouse, or garnishing your wages once ordered by the court.

Our billing staff can work with you to create a convenient payment plan before your account becomes delinquent and is sent to our collections department for legal action. Please contact them directly at (315) 362-5287 or by e-mail at ps@mmri-ny.com to make these financial arrangements.