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Insurance and Billing

Our Policies

Associates for Women's Medicine participates with multiple insurance plans. (see list below). Since there are hundreds of insurance plans, we ask our patients to be familiar with your own healthcare coverage and its limits. We will submit claims for those insurance plans with which we are contracted. However, the basic responsibility for payment lies with the patient.

If your insurance company requires a co-payment for visits, we require that this be paid at the time of service. If you are not prepared to pay your copay at the time of the visit, it may mean rescheduling your appointment. We provide a variety of payment options by accepting VISA, Mastercard and Discover; in addition to cash or check. If you are having an office based procedure, our billing staff will evaluate your benefits and advise you prior to your appointment of any deductible, coinsurance or copay required to be paid at the time of the service.

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 the date of service.

Please bring your current health insurance card with you at the time of each visit. You will be asked to present it to the front desk staff upon check-in at each visit. We cannot file insurance without a current insurance card, and this could result in rescheduling your appointment or requesting payment at the time of service until we receive insurance we can verify.

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 of the specific requirements of your insurance; especially copays as well as laboratory and radiology facilities you may utilize. Please check your plan coverage to determine the facility to avoid unnecessary costs to you. The physician'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 company.


Payment for Services Performed

All payments are expected at the time of service and any outstanding balances are due within 30 days of hearing from your insurance company, 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 an 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.

Fees are for services rendered. If Associates for Women's Medicine receives monies from a third party compensation for services previously paid by the patient, a patient refund will be generated within 30 days.


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.

Billing For Obstetrical Care

Our goal is to make the financial aspect of your pregnancy as easy as possible! During the first few weeks of your pregnancy, we will verify eligibility and coverage benefits with your insurance carrier. Our office with then inform you of your financial obligation to our office. Please note: THIS IS NOT A GUARANTEE OF PAYMENT. We recommend that you contact your insurance plan personally to confirm the information. If your insurance coverage changes during your pregnancy, it is your responsibility to notify the business office as soon as possible.

This amount reflects the portion of your bill we estimate the insurance will not cover. This is only an estimate. The total amount of your financial obligation must be paid before the beginning of your seventh month. If it is necessary for you to leave our practice, you will be billed for all care provided up to the time of your departure.


Our Fees

Fees for a normal, uncomplicated pregnancy are based on prenatal visits, delivery and a normal post-partum check.

Our fees do NOT include:

  • Fetal Non-stress tests
  • Laboratory tests, pap smears, cultures.
  • Radiologic studies (Ultrasounds, X-rays, etc.)
  • Anesthesia during Childbirth
  • Hospital charges
  • Circumcision
  • Newborn hospital care.
  • Infant care after delivery.

Billing for surgical procedures

If it is determined that you require a surgical procedure; either outpatient or in-patient, you will be contacted by a representative from our billing department to discuss the portion of your bill we estimate the insurance will not cover. Again, this in only an estimate. The total amount of your financial obligation is due to our office prior to your surgery, unless prior arrangements have been made with our billing staff.


Precertification

Many surgeries, procedures and diagnostic studies require pre-certification by your insurance company to verify benefits and obtain preauthorization and approval. Our office will assist you with this process. However, this is not a guarantee of payment. To determine what your insurance plan covers and what your financial obligation may be, call the customer service or member services department of your insurance company (the telephone numbers are on your insurance card)


Insurance Plans

Associates for Women's Medicine participates in the following insurance and managed care programs. The insurance contracts are frequently reviewed and changed. Therefore, prior to your visit, please contact us or your health plan to verify our participation in your plan.

  • Aetna Health Plans
  • Aetna Better Health
  • AmeriHealth
  • AmeriHealth Administrators
  • CIGNA Health Plans
  • Coventry Health Plans
  • Coventry Cares
  • Devon Health Services
  • First Health
  • Great West Healthcare
  • Health America/Health Assurance
  • Independence Blue Cross
  • Intergroup
  • Keystone Health Plan east
  • Medical Assistance (St ate of PA)
  • Medicare
  • MultiPlan (card must state PHCS also)
  • PA Blue Cross/Blue Shield
  • Personal Choice
  • Preferred Care
  • Preferred Health Care
  • United Community Plan
  • United HealthCare

If we do not participate with your insurance company, we will bill your insurance carrier as a courtesy, but fees for services rendered will be due at the time of service unless other financial arrangements have been made prior to the date of service. If you have any questions about your insurance coverage please do not hesitate to contact our billing office at (610) 363-1626.

Last Updated: 1/7/2014