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Insurance and Billing

The Women's Specialty Center participates in most managed care programs. Our Financial policy is dedicated to providing our patients with the best possible care and services while keeping the costs to you from increasing at an unreasonable rate. The managed care programs we participate with constantly changes, please check with our business office for the latest update.

Certain insurance plans require a co-payment and this must be paid at the time of the visit. Managed care plans may have restrictions with respect to hospitals, referral physicians, as well as the type and extent of treatment. Changes in hospitals, participating physicians, labs, and ancillary service providers occur continuously, and it is your responsibility to know where your insurance allows you to have ancillary testing. While we make every effort to keep abreast of these modifications and relay them to you, it is ultimately the patient's responsibility to make certain her program approves of the choice of hospital, physician, or laboratory where she has been referred. We recommend careful review of your plan's benefits and suggest contacting your program's patient relations representative for explanations.

Payment will be requested at the time of service for all services that are non-covered or determined to be the patient's responsibility, including co-payments. Payment may be made by cash, check, Debit Card, MasterCard, Visa and Discover.

If we DO NOT participate with your insurance company, this means that we will bill your insurance carrier as a courtesy but fees for services rendered will be due at the time services are rendered unless other financial arrangements have been made prior to date of service.

It is important for you to understand that your health insurance coverage is an agreement between you and your insurance company. It is also important for you to know all the specific requirements of your insurance especially co pays and which labs we can use. Your doctor's bill for the services provided to you is an agreement between you and your Provider. If you receive a statement from our office and disagree how your insurance processed the claim, please call your insurance.

Payment for services performed
Our office accepts Visa, MasterCard, Discovery and Debit cards for your convenience, as well as cash or a check. All payments are expected at the time of service and any outstanding balances are due within 30 days, unless prior arrangements have been made with the Billing Department. All balances that reach 90 days past due with no activity will be sent to a collection agency. Should your account be sent to a collection agency, you will be financially responsible for all collection fees and legal fees that our office incurs through the process utilized to collect the outstanding delinquent balance.

Payment in full of any past due balance is expected prior to being seen in our office in the future. In addition, payment in full will be expected at the time of service for any future services.

Medicare Patients
All Medicare patients will be asked to sign an Advance Beneficiary Notice upon check-in for their office visit. An Advance Beneficiary Notice, or ABN, is a written notice from Medicare given to you before receiving certain items or services, notifying you:

  • Medicare may deny payment for that specific procedure or treatment.
  • You will be personally responsible for full payment if Medicare denies payment.

Medicare requires our office to have you sign this form prior to services being rendered. An ABN gives you the opportunity to accept or refuse the items or services and protects you from unexpected financial liability in cases where Medicare denies payment. It also offers you the right to appeal Medicare's decision. However, you should follow your physician's recommendations regarding the timeliness of your exams.

Coordination of Benefits
Most insurance companies are sending letters to subscribers the first of the year requesting if the subscriber or dependents has any other insurance coverage. This information must be completed. Remember for children if they are covered under both parents policy, the Birthday Rule applies. In this case, the primary insurance would be the parent whose birthday falls first in the calendar year (not who is older). For this reason, we need to have birth dates as well as the social security number of the subscriber on file in our office. Your insurance will not pay on claims until they receive this information. If you have questions, please call our Billing Office.

Fees
Our fees are within the customary range for this area and reflect the level of care you will receive. We have standardized charges for various procedures. If you have any questions about fees, please feel free to call and discuss them with our billing department 610.363.1626.

Pre-certification
Many procedures or treatment plans require pre-certification by your insurance company to verify benefits and obtain preauthorization and approval. Our office does the pre-certification. If you have questions concerning verification of benefits or preauthorization please contact our billing department at T 610.363.1626 or F 610.350.2691 for further assistance.

If you require a surgical procedure, and it is determined that you have a large out of pocket expense, someone from the billing department will meet with you to discuss payment options prior to your procedure.

Cancellation: (office visits, procedures and surgery)
Please give us 24 hours notice for cancellation of appointments. If you are unable to reach the office during hours, you may leave a message canceling your appointment on our off-hour telephone message.

Last Updated: 7/11/2013