Financial Policy



Financial Policy

Welcome and thank you for choosing Medical Support Services for your therapeutic treatment. We will provide you with the very best quality care.

NOTE: Your insurance is an agreement between you, your employer and your insurance company. Medical Support Services is not party to that contract. You are personally responsible for the cost of all services rendered to you in our office.

Your Responsibility

You agree to provide us with a copy of your insurance card(s). Until you provide us with complete and accurate information for billing your insurance company, you agree to pay at the time the services are provided.

You agree to contact your insurance company to determine your coverage and responsibility for referrals, pre-authorizations, deductibles, co-pays and co-insurance. It is our responsibility to notify all patients and patients’ families that some insurance agencies are mailing checks directly to the member. If you receive insurance checks, it would then be your responsibility to endorse the check and make it payable to Medical Support Services within 10 days of receipt. If you do not turn over the checks that have been paid to you, then services will become your responsibility and need to be paid for at the time of service.

Our Responsibility

As a courtesy to our patients, Medical Support Services will submit your claims on your behalf in a timely and accurate fashion. If insurance information is not provided to us, payment will be expected and collected at the time of service.

Our fees fall within the usual, customary and reasonable (UCR) rates for this area. Each insurance plan defines their individual UCR.

Our goal is to work with you and your insurance company so that you may receive the maximum benefit allowed by your insurance plan. We will continue to access your commercial insurance as your primary payer source. The procedure for unpaid insurance claims are as follows:

1. After 30 days our office will follow up with the insurance verbally.

2. After 60 days you will receive a letter to inform you of the outstanding charges. We will provide you with all the information needed to contact your insurance carrier and assist with the processing of your claims.

3. After 90 days, all unpaid claims will be invoiced to you as Patient Responsibility. The invoice will be due in our office within 30 days of your invoice. If not received within the timeframe indicated, late fees will be assessed, which will become patient responsibility and cannot be paid by insurance carriers.

Cancellations

As a courtesy to our patients and staff a 2-hour notice is required when canceling appointments. If there is a no call no show then you will be billed a $25.00 service fee that cannot be billed to your insurance. (Please see our cancellation Policy for more detailed information.)

Payment At Time Of Service

Medical Support Services offers discounted rates if you are paying out of pocket. Please ask one of our friendly front desk staff for further details. Please be informed that Medical Support Services collects all known co-pays, co-insurances and deductibles at the time services are rendered.

Collections

We understand your financial obligations and will work with you on a reasonable payment plan for balances due. However, if payment arrangements are not made monthly we will turn your account over to a collection agency for payment in full.

Medical Support Services has an additional processing fee to all open balances. Dollar amounts payable by insurance will be excluded. The fee will be added on the first of every month. Co-insurance, deductibles, and co-pays are due at the time of service. The fee structure will be as follows:

31-60 days-$10 fee

61-90 days-$15 fee

91-120 days-$20 fee

Any balances open over 120 days will be turned over to a collection agency.

** There will be a $25.00 NSF fee added for any returned checks**

If you need to set up a payment schedule for unpaid balances, please contact Leslie D, accounts manager at 262-886-3431.

------------------------------------------------------------------------------------------------------------

I have read and agree to the terms of this financial policy. I assign my insurance company to pay Medical Support Services for services provided to me. I consent to the release of my medical records to facilitate insurance payments and as to care as ordered by my physician. I may call 262-886.3431 and ask for clarification at any time. I understand I may have a copy of this policy for reference.

Signed___________________________ Date______________________________

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download