Most health plans have provisions for coordination of benefits with other health care plans covering you or any of your covered dependents. This prevents overpayments to health care service providers. If you are covered by more than one insurance plan (including Workers’ Compensation and auto insurance), the plans will coordinate the payment of costs so that total payments will not exceed your actual expenses.

If you are covered by more than one medical plan, contact each health plan for more information on coordination of benefits and in which order to file your claims.

If you have Medicare and other health insurance or coverage, be sure to tell us. This will help us send your bills to the correct payer to avoid delays. Whether Medicare pays first or second depends on a number of things. You should consider those listed in this chart to help find who pays first. However, this chart doesn’t cover every situation. If you have questions about who pays first or if your insurance changes, call the Medicare Coordination of Benefits Contractor at 1-800-999-1118. TTY users should call 1-800-318-8782.

At the completion of your appointment, you may be asked for payment for your office visit, diagnostic testing, or minor office procedure.
Our professional fees are due and payable at the time services are rendered to you.  If you have insurance coverage, we have subtracted from our fee the amount we expect your insurer to pay, as well as any applicable insurance discounts.  The amount remaining that will not be paid by insurance is your responsibility.  The following are descriptions of the amounts that are not paid by insurance, as stipulated in your insurance contract, and are sometimes referred to as “cost-sharing” provisions:

·         Co-Payments (Co-pays) – This is a fixed dollar amount, usually $5 - $30, that you must pay at each office visit.  This amount may be different depending on whether you are seeing your primary care physician or you are seeing a specialist.  We are a specialist’s office.

·         Co-Insurance – This is a percentage (%), usually 10% - 30%, of the physician’s fee that you must pay.  Your payment plus your insurance company’s payment will equal 100% of your doctor’s fee, less any insurance discounts applicable to your plan.

·         Deductible – This is a fixed dollar amount, usually $250 - $1500, that you must pay each year for certain health care services before your insurance will pay anything.  Once you have “met your deductible” requirement, then your insurance will pay according to the other provisions of your contract.

·         Non-covered benefits – Certain services may be specifically excluded from your insurance policy.  Services for infertility, impotence or erectile dysfunction, and voluntary sterilization (vasectomy) are often excluded from insurance policies.  Sometimes they may eventually be payable, but only after a review by your insurance company for “medical necessity.”.