INSURANCE AND BILLING
There are no “free” visits. Any time you are seen by one of our providers there will be a charge for their services. There are limited exceptions to this rule (additional immunizations in a series, or suture removal, for example). If you are here for suture removal or additional immunizations, and only have the sutures removed or the immunization given, there will not be a charge for the visit. If you ask the doctor additional questions related to anything other than the suture removal or immunization (that you have a cough, or chest pain, for example) you will be charged for an office visit and the applicable co-payment, co-insurance or deductible will apply.
Your insurance company should provide an Explanation of Benefits (EOB) which shows the amount you are responsible for. Your insurance benefits determine this amount. We only bill you for what your insurance benefits do not cover.
If you do not have insurance, we will still be able to see you as a self-pay patient. At the time of your office visit, a $100.00 deposit may be required. If there are any additional fees, we will collect these at the end of the visit, when charges are determined.
We are more than willing to work with you toward payment of your statement through a payment plan. In order to initiate a payment plan, we require a credit card on file for which we will charge the monthly payment that you have designated us to do so on the designated date. We have a form to fill out for keeping your credit card information. This information is kept in a secure safe until needed.
If you have any questions regarding problems with your insurance, or questions regarding your account with DTC Family Health and Walk-In, please call (303) 771-3939 ext 117 or call Pricilla directly at (720) 412-3533.
BILLING- HEALTH INSURANCE
As a courtesy, we will bill your primary and secondary insurance carrier on your behalf. However, you are ultimately responsible for payment of your bill. Please remember that your health insurance policy is a contract between you and your Health Insurance Company, not between the Provider and the insurance company.
In order to be able to properly bill your insurance company, YOU MUST PRESENT A CURRENT INSURANCE CARD AT EACH VISIT. If your insurance company requires you to pick a Primary Care Physician (PCP) and we are not the primary care physician (PCP) on your card, we will be unable to accept your insurance card. We will try to send the claim to your insurance for processing, but it will be your responsibility to present to us a card with one of our physicians listed as your primary care physician (PCP).
CO-PAY AND COVERAGE
As a patient, it is in your best interest to know and understand your responsibility for any co-payment, deductible and/or co-insurance as determined by your contract with your insurance carrier prior to your visit. Copayments are due at the time of service. Your insurance company requires that we collect the co- payment at the time of service. This is part of your contract with the insurance company.
Not all services are covered in all insurance contracts. If your insurance plan does not cover a service or procedure, you may be liable for full payment of the bill. Any questions or complaints regarding your coverage should be directed to your insurance carrier.
GLOSSARY OF TERMS
The part of your bill, in addition to co-pay, that you must pay. Co-insurance is usually a percentage of the total medical bill – for example, 20 percent.
The cost-sharing part of your bill that is a fixed dollar amount designated by your insurance company that is your responsibility to pay at each visit (also known as “co-pay”). Co-payments can range anywhere from $5 to $50 per visit. Please be aware that there may be different co-payments for Primary Care Physicians (PCP) and Specialists.
The amount of cost sharing that you must pay for medical services BEFORE your health insurance company starts to pay.
Any patient over the age of 18, or an emancipated minor, who will be held financially responsible for all charges incurred; in short, the person who will be receiving the statements.
This is the person who holds the insurance. This can be different from the responsible party.
Initial Office Visit vs. Established Office Visit
We are required to follow the AMA and CMS guidelines for billing. There are two sets of codes for office visit billing – one set for new patients and one set for established patients*. If it is your first visit to our practice within 3 years, you are charged an initial office visit. This ensures that we comply with billing guidelines.
*A new patient is defined as someone who has not received services from any
provider in the practice within three years.
*An established patient is defined as someone who has received services from a provider in the practice within the past 3 years.
During an initial office visit, we are required to perform several “behind the scenes” services, for example reviewing and updating your medical history. After your initial office visit, all subsequent visits will be billed as established office visits, as long as it has been less than 3 years since your last visit to our office.