| Payment and Insurance
A current, valid insurance card(s) must be presented at each visit. We file claims with insurance companies for which we participate; however, all charges are your responsibility from the date the services are rendered. Not every service is a covered benefit in all contracts. It is important that you read and understand your health insurance policy and its requirements for coverage so that you will not incur any unexpected charges.
Co-payments, deductibles, and co-insurance are determined by your insurance plan and represent an agreement between you and your insurance company. Co-payments are due at the time services are rendered. If the deductible and/or co-insurance amounts are known, payment will be expected at the time of service. Otherwise you will be forwarded a statement for any deductible or co-insurance amounts as determined by your insurance company.
We appreciate your prompt payment. As a reminder, outstanding balances are due fourteen (14) days from the date of the statement. Unpaid balances may affect your ability to schedule an appointment. Balances older than thirty (30) days are subject to collections proceedings.
Insurance Participation List Medicare
We do accept Medicare and some Medicare managed care products. If we participate, we will file your secondary insurance as a courtesy to you. We do ask that you pay the annual deductible (2007 deductible for Part B is $131) and co-insurance ( 20% of the Medicare-approved amount after you meet the $131 deductible) at the time of service if applicable. Please review your Medicare benefits. We do not offer the initial “Welcome to Medicare” physical exam because of the vision and electrocardiogram requirements. Please refer to your primary care provider for the initial preventative physical exam benefit.
Preventative services (“annuals” or “wellness” exams) and most screening exams are not covered by Medicare. A breast and pelvic exam are covered by Medicare every two (2) years. A bone mass measurement is covered by Medicare every two (2) years. If we suspect that a service is not covered by Medicare, we are required by Medicare to request that you read and sign an advanced beneficiary notice or ABN. Payment is expected in full at the time of service for those services that are not covered by Medicare.
Advance Beneficiary Notice (ABN)
Please refer to the following documents for more information regarding Medicare benefits.
Breast and Pelvic Exam
Bone Mass Measurement Exam
Hemocult/fecal blood testing
Mammography
Medicaid
Gynecological Patients
Central Carolina Women's Center will only accept Medicaid recipients who are referred by another physician or healthcare entity. Patients who are Carolina Access recipients must be referred by a primary care provider for the initial visit and each subsequent visit. Medicaid recipients who are planning to have surgery must present a valid, current Medicaid card before the surgery is scheduled.
Obstetrical Patients
Central Carolina Women's Center will accept Medicaid recipients who are pregnant. It is the patient's responsibility to present a valid, current Medicaid card at each visit . Patients who present without their Medicaid card will be asked to reschedule their appointment. If rescheduling is not possible, the patient will be treated as “self pay” and expected to pay for services at the time they are rendered. Medicaid will not be filed retroactively for the visits in which a Medicaid card was not presented and the patient will be responsible for the charge.
Retroactive Medicaid
Surgical Candidates, Non-obstetrical
Referred patients must present a valid, current Medicaid card prior to scheduling surgery. Retroactive Medicaid, primary or secondary, is not accepted for planned surgery.
Obstetrical Patients
Patients must present a valid, current Medicaid card prior to initiation of an obstetrical record. Retroactive primary Medicaid will not be accepted once the patient has made three (3) consecutive payments to the obstetrical payment plan. Retroactive secondary Medicaid will not be accepted under any circumstances. Primary emergency Medicaid will not be accepted for established patients who have initiated a payment plan. Secondary emergency Medicaid will not be accepted.
Gynecological Patients
Because Central Carolina Women's Center does not schedule self referred Medicaid recipients seeking gynecological care, retroactive Medicaid is not considered. Referred Medicaid recipients seeking gynecological care who are identified for surgery must follow the requirements for surgical candidates.
Emergency Medicaid
Surgical Candidates, Non-obstetrical
Referred patients must present a valid, current Medicaid card prior to scheduling surgery. Primary Emergency Medicaid is not accepted for planned surgery. Secondary emergency Medicaid will not be accepted.
Obstetrical Patients
Patients must present a valid, current Medicaid card prior to initiation of an obstetrical record. Emergency primary Medicaid will not be accepted once the patient has made three (3) consecutive payments to the obstetrical payment plan. Secondary emergency Medicaid will not be accepted.
Gynecological Patients
Because Central Carolina Women's Center does not schedule self referred Medicaid recipients seeking gynecological care, retroactive Medicaid is not considered. Referred Medicaid recipients seeking gynecological care who are identified for surgery must follow the requirements for surgical candidates described under item C., first bullet.
Payment Planning
Obstetrical payment planning is provided as a courtesy to help our patients avoid being burdened by a large bill at the end of their pregnancy. After your initial obstetrical visit, a staff member will contact your insurance company to determine your financial responsibility related to any co-payment, co-insurance, or deductible. A payment plan is calculated by dividing your financial responsibility into equal monthly payments. The payment plan may be extended to six (6) months depending upon the balance. You are expected to make timely payments in accordance with the payment plan schedule. The total payment plan amount is only an estimate…you may owe a balance at the end of the pregnancy or the patient may be due a credit for overpayment. The obstetrical payment plan includes prenatal services, delivery, and the post partum visit. Hospital services, anesthesia, pathology, lab, etc are billed separately. Any problems encountered during the pregnancy that generate a visit are not included in the payment plan. Charges for those services may be subject to a co-payment and are due at the time services are rendered.
The routine screening ultrasound performed between 18-20 weeks of pregnancy is not included in the obstetrical payment plan. Payment of the routine screening ultrasound is insurance/managed care plan specific. The routine screening ultrasound is billed at the time of service. Therefore, payment is expected for any balance resulting from a deductible or coinsurance requirement.
Discounts
Central Carolina Women's Center will offer discounts for patients who are determined to be in financial hardship. The 2005 Poverty Guidelines published by the NC Department of Health and Human Services will be used to determine a patient's eligibility for a financial hardship discount. Discounts range from 20% to 80%.
Indigent candidates must provide last year's tax returns as evidence of family size and income. In the absence of a tax return, the indigent candidate may provide the previous month's bank statement. If the indigent candidate can not or will not provide proof of family size and income, the practice administrator will work with the staff and patient to determine if other options can be considered.
Fees
In 2005 our charges were evaluated and updated. All charges were adjusted based on the 2005 Physicians' Fee and Coding Guide published by MAG Mutual®. The publication was used to assist our organization in analyzing our charge structure. The charge recommendations are based on a combination of Medicare's relative values, health insurer's data bases, and geographic location.
When reviewing your charges for services rendered, please consider that the charges include the time and complexity of your condition as well as the other services such as front staff, clinical staff, medical equipment, medical and office supplies, billing and statement expenses, photocopying expense, rent/mortgage, educational materials, telephone triage service, postage, 24 hour/365 days a year emergency coverage, insurance, utilities, etc.
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