Billing & Insurance

Financial Policy

To help provide the most efficient and reasonable health care services, it is necessary for us to have a Financial Policy stating our requirements for payment of services provided to our patients. Patients are responsible for the payment of all services provided by our facilities and affiliates. It is our policy to file insurance as a courtesy to you, if we have accurate and complete insurance information. The balance due is still your responsibility if we have not received payment from the insurance company within 30 days.

If  you have insurance and we file with your carrier, we ask that you pay ahead of time on the balance which is your responsibility according to your plan (i.e. any deductible, co-pay, co-insurance amounts). Since we are not party to the agreement between you and your insurance company, we ask that you assist us in contacting them in the event that services are not paid within 30 days.

For patients with private insurance as your primary or secondary carrier we can only provide you with an estimate of the costs of services. We obtain this information by contacting the insurance carrier and referencing our contracts with your carrier. The outstanding balance on your deductible is only an estimate. If a refund is due after payment is received, it will be issued to you in the form of a check via USPS.

For Worker’s Compensation claims, it is our policy to bill your employer or the Worker’s Compensation carrier for services rendered. If you are covered, we will accept the payment made by Worker’s Compensation as payment in full. If Worker’s Compensation denies payment or goes into litigation, the entire balance will become your responsibility and will be due within 10 days from the date of the denial. It is your responsibility to contact us with the name and address of your employer or the insurance company at the time the appointment is made and to provide the office with a copy of your Notice of Compensation Payable Letter from Worker’s Compensation. All insurance is verified prior to the patient’s initial visit.

If you do not have insurance and are not covered by Medicare, you will be considered a “SELF PAY” patient Payment is due in full at the time of service.

PAYMENT POLICY: Payment in full is due at the time of service. We accept money orders, cashier’s checks, debit cards, and all major credit cards. We also participate with CareCredit.

RETURNED CHECK FEE: A $35.00 fee will be charged for any check returned due to insufficient funds.

URINALYSIS FEE: A $25.00 fee will be charged for a urinary drug screen (UDS) not covered by insurance or when the deductible has not been met. It is the policy of this practice to conduct random UDS testing at least twice in a 12-month period and more frequently as indicated.

Patient “no shows” and cancellations are a tremendous loss for a practice. Please help our office reduce those losses by canceling within 24 hours if you cannot keep your appointment. Failure to give notice 24 hours prior to your appointment will result in a $30 fee to be paid by the patient.

INSURED PATIENTS’ POLICY:

INSURED PATIENTS’ POLICY:

  • YOUR INSURANCE. Your insurance is a contract between you and your insurance carrier. It is your responsibility to know the benefits and comply with the requirements of your insurance plan. It is also your responsibility to notify us of any changes made to your insurance coverage, such as obtaining new insurance coverage, terminating an existing insurance policy, or changes to existing insurance coverage.
  • NETWORK PROVIDERS. Our providers are contracted with most major insurance payers, including the Federal Medicare and Medicaid programs. As contracted providers, we are obligated to follow the terms and requirements of our contracts. If we are not contracted with your insurance carrier (a “Non-Participating Insurance Provider”), payment in full is expected at the time of service.
  • INSURANCE VERIFICATION. We will verify your insurance and benefits eligibility prior to every patient visit. If we are unable to verify your insurance due to incomplete or inaccurate information, payment in full is expected at the time of service, or we may need to reschedule your appointment to a more convenient time.
  • If a referral is required by your insurance carrier, it is the policy of this practice not to schedule an initial appointment until that referral has been received from the patient’s primary care physician or specialist. Please be advised that with some insurance companies it can take up to 48 HOURS to obtain a referral authorization. If you do not have the required referral, we may need to reschedule your appointment to a more convenient time.
  • CLAIM SUBMISSION. As a courtesy to the patient, we will file primary and secondary insurance on your behalf, provided we have complete and accurate insurance information at the time of service.
  • WORKER’S COMPENSATION CLAIM SUBMISSION. If treatment is due to a work-related injury, as a courtesy to the patient, we will file a worker’s compensation claim to the appropriate carrier on your behalf, provided we have complete and accurate insurance information at the time of service.
  • PATIENT RESPONSIBILITY. At the time of service, it is the policy of this practice to collect co-pays, deductibles, and any non-covered benefits due to policy limits or policy exclusions, as well as failure to comply with your insurance plan requirements. As a courtesy to the patient, our office can estimate the co-insurance patient responsibility based on the services provided and the information received from your insurance company during the verification process.
  • STATEMENT. Once insurance has made payment, you will receive a statement for any balance owed. It is the policy of this practice that balances must be paid in full WITHIN 60 DAYS of the date of the initial statement. It is the responsibility of the patient to inform our office of any address changes. Our office is not responsible for statements, collection notices, or payments lost in mail delivery.

COLLECTIONS. If payment in full is not made WITHIN 60 DAYS of the date of the initial statement, or satisfactory payment arrangements have not been made with our office, then your account will be in default and may be referred to a collection agency. SHOULD THE PATIENT’S ACCOUNT BE REFERRED TO A COLLECTION AGENCY FOR NONPAYMENT, YOU AGREE TO PAY ALL COSTS OF COLLECTION, INCLUDING CONTINGENCY COLLECTION FEES AND ALL REASONABLE ATTORNEY FEES AND COURT COSTS. SUCH CONTINGENCY FEE WILL BE ADDED TO AND COLLECTED BY THE COLLECTION AGENCY IMMEDIATELY UPON YOUR DEFAULT AND THE REFERRAL OF YOUR ACCOUNT TO SAID COLLECTION AGENCY.

Effective January 1, 2022, the No Surprises Act, which Congress passed as part of the Consolidated Appropriations Act of 2021, is designed to protect patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities, holding them liable only for in-network cost-sharing amounts. The No Surprises Act also enables uninsured patients to receive a good faith estimate of the cost of care.

Billing Disclosures – Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “Balance Billing”, Sometimes Called “Surprise Billing”? When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a healthcare facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care–like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

The federal “No Surprises Act” grants consumers the right to receive a “Good Faith Estimate” explaining how much their medical and mental health care will cost. Under the law, health care providers, including psychotherapists, must give clients who don’t have insurance or who are not using insurance an estimate of the expected charges for treatment services.

The act also requires healthcare providers, including psychotherapists, to inform their clients of this right. Additionally, this act requires that information regarding the availability of a “Good Faith Estimate” must be prominently displayed on the website of all health care providers, including psychotherapists. You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.

You can ask all of your health care providers, including your therapist and other providers from whom you seek treatment, for a Good Faith Estimate before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/.

INSURANCE:

INSURANCE:

Madison Medical Associates (MMA) participates with most major carriers. Please consult your insurance carrier or contact one of our scheduling representatives prior to your appointment to verify our participation status with your insurance plan.

Insurance is an important part of health care for all of our patients. We want to make sure that you don’t have any stress revolving around your insurance coverage and we have provided information below.

Office Visit Authorization

We will make every effort to obtain authorization from your insurance company before you walk into the office. However, please know that despite our best efforts there are some insurance companies that require you to obtain a referral from your primary care physician before your appointment.

If you are required to have a referral from your primary physician, this must be done at least three days before your appointment at MMA.  This will ensure that we have the authorization needed before you come in so that there is no delay in your visit with one of our doctors.

If needed, it is important to get this referral because if you arrive for your appointment without it, you may be required to reschedule your appointment.

Authorization for Diagnostic Testing Services

MMA will handle authorizations for all the tests requested by physicians when necessary.

Because insurance companies have their own rules regarding diagnostic testing services, a representative from MMA will contact your insurance company, your primary care physician or, in the event of a worker’s compensation claim, the workers’ compensation adjuster to obtain authorization for the tests requested by the doctor.

Following authorization, you will get a phone call from our representative to schedule the tests.

Bracing

Madison Medical Associates has a Bracing Department that provides you with braces and supports when ordered by our physicians. For your convenience, these items are usually available at MMA and can be fitted by one of our specialist. We charge a deposit for each item being prescribed and you will receive an estimated amount of what you will personally be responsible for. If this deposit exceeds the true financial responsibility for braces or equipment, that overage will be either credited back to any open balances you have with us or refunded to you. You will still be responsible to pay any amounts not covered by the deposit including any insurance deductibles that are noted in the patient explanation of benefits.