| As your healthcare provider we will file your claims with your insurance company as a courtesy after services are provided. However, it is your responsibility to understand what services are covered under your medical insurance policy. If you have any questions whether a service will be covered we urge you to contact your insurance company before the service is provided.
The codes that are listed for the services that are provided to you are based on the guidelines of the American Medical Association. There are several factors involved when making the decision for the type of services to be billed. Among those deciding factors is whether you are a new patient (not seen within the last three years) or established patient, the reason for the visit, the amount of time the service takes and the complexity of the medical problem.
Insurance companies make their payment decision about a specific medical service by looking at what your insurance policy provides. (Example: If the reason for your visit is a sport physical and your insurance company does not cover that service we cannot go back and change the reason for your visit) It is your responsibility to understand what your plan covers prior to your visit.
Sometimes routine services such as office visits, laboratory services, mammograms, screenings, and annual physicals are not covered under insurance policies. Again, we strongly suggest you contact your insurance company to find out what benefits you have under your policy, before services are rendered. The customer service number for your insurance carrier is usually found on your insurance card.
Be advised that your insurance company may require a pre-certification, prior authorization, or referral for some services, such as radiology, surgery, or specialist visits. Receiving prior authorization does not guarantee that your insurance company will pay for it. |