PCHP Billing & Financial Policies Monthly, PCHP mails statements detailing the patient responsible
balance due. Payment of all outstanding patient and/or the responsible party
balances is due upon receipt. Please call the PCHP Business Office @ 802-846-3090
or toll-free 866-866-2616 with any questions or if you would like to make payment
arrangements. Unpaid balances, outstanding for over 90 days ,will qualify for
our pre-collection process.
We will file your claim to participating insurance plans but you
are ultimately responsible for paying for the services provided in our office.
Unfortunately insurance companies do not cover and pay for all
services. In cases where the service has not been paid, you will be responsible
for the bill. Before we bill you, we will make sure that all the information
sent to your insurance company is accurate and clearly describes the services
you received.
We participate with most of the insurance plans and companies
in the area, which means we will accept their allowable fee schedule and will
apply their payment(s) and corresponding adjustments per the terms of their
contract. Please be advised that you may still be responsible to pay any applicable
co-payments and/or coinsurance or deductible amounts. If we do not participate
with your particular plan, however, you will be responsible for paying the bill
at the time of service.
If we have not received payment from your insurance company within
45 days of the date of your visit, you will be expected to pay the balance in
full. You are responsible for all charges.
You are expected to pay your deductible and co-payment at the
time of the service. PCHP health centers usually accept cash, in-state personal
checks, as well as Visa, Master Card, American Express, and Discover cards.
There is a service charge of $20.00 for returned checks.
If you cannot provide evidence of medical insurance, we expect
payment at time of service.
We will gladly refund overpayments upon written request to the
responsible party within 30 days.
Non Covered Services
Most insurance companies or plans do not pay all medical services, even those
that might be helpful to the patient.
When the service is not covered by your insurance policy, you
will be responsible for paying the bill.
We cannot change information on an insurance claim in order for
the claim to be processed and paid.
There are many different insurance plans, even if written by the
same company. The particular services for which you are covered are outlined
in your contract. If you are not sure, please contact your employer or insurance
agent.
Please present your insurance card to our receptionist at every
visit so that we are always sure to have your correct insurance information
Non-Participating Insurance Plans
PCHP participates with most of the insurance plans and companies in our area,
which means we will accept their allowable fee schedule and will apply their
payment(s) and corresponding adjustments per the terms of their contract. Please
be advised that you may still be responsible to pay any applicable co-payments
and/or coinsurance or deductible amounts.
However, if we do not participate with your particular plan, you
will be responsible for paying the bill at the time of service. As a courtesy
to you, PCHP has submitted an insurance claim to your nonparticipating insurance
plan for review and payment processing. Since we do not participate with this
plan, it is your responsibility to follow up with your insurance company regarding
the status of this insurance claim. Since PCHP does not have an agreement with
your insurance company to accept the assignment of direct payments, please be
advised that PCHP is and will NOT be accepting assignment for the charges associated
with this claim. Therefore, you are fully responsible for payment of this and
any other outstanding patient responsible balance due. Any questions that you
have regarding the status of your claim should be directed to the telephone
number on your insurance card.
PCHP expects that all outstanding patient responsible balances
be paid within a reasonable time frame of 2-3 months. If you are unable to make
payment in full, an agreed upon payment plan and schedule that you will be asked
to confirm in writing can be established. You can make these payment arrangements
with us during your visit or you can contact the PCHP Billing Office (1-877-876-2817)
to set-up your payment plan and schedule. Should you miss two (2) scheduled
payments, your total account balance will be due immediately.
You will receive a monthly statement from the PCHP Billing Office
indicating your outstanding balance due as well as any payments received. Failure
to make payment may result in your balance being referred for collection action
& follow-up.
Managed Care (e.g. HMO, PPO, etc.) Plans
Before seeing most consulting specialists you must receive a referral from our
office or payment will be denied by most managed care insurance companies.
Missed Appointments/Late Cancellations
Missed appointments are costly to us, to you, and deny access to other patients
who could have been seen in the time set aside for you. Cancellations should
be made 24 hours before the appointment. We reserve the right to charge $25
for missed appointments and late cancellations.
Annual Examinations and Other Physicals
As a commitment to your health, we recommend that every patient have an “annual
exam” that allows us to evaluate your overall health picture and make
sure you are not developing any unexpected problems or illnesses.
During this visit we will update all of your known conditions
as well as look for any new problems. Unless there is some major new finding
during this annual examination, we must submit the service to your insurance
company as an annual examination, which may not be paid for by your insurance
plan.
Along with the examination, your doctor might suggest also some
“screening tests” be performed to allow him or her to get a better
picture of your health. These services may also be considered non-covered by
your plan, and you will be expected to pay for them yourself.
Even if the results of these tests show some problem, we must
submit these tests as “screening” to your insurance company and
cannot change the information on the claim just to receive payment for the services
from the insurance company.
Also, insurance companies, which pay for preventive care, will
pay for only one health maintenance visit a year. Health maintenance exams include
annual physicals with PAP, physicals without PAP, and gyn exams with PAP.
The choice is up to you. Some insurance companies will pay for
an annual well-woman exam only (gyn exam with PAP) and not for a full physical.
Medicare does not pay for physicals at all except for a gyn physical
with PAP every two years.
Insurance companies generally do not pay for school, camp, employment
or drivers physicals. You will be expected to pay at time of service.
We will be glad to work with you to develop a payment plan for
non-covered services, but these arrangements will need to be made in advance.
Insurance Filing and the Law
Recent Federal laws addressing all insurance companies require that we submit
every claim to insurance company accurately, reporting the exact services performed
and the reason for performing them. We are no longer allowed to change this
information in order for the insurance company to process and pay your claim.
Our practice is committed to these new laws and will submit all
claims to all insurance companies in this manner.
If you need assistance, or have questions, please contact
us today.
