Ann Shippy, MD

Available Forms

Authorization for Use and Disclosure of Protected Health Information Female Intake Form Informed Consent for Telehealth Consultations Insurance Policy Male Intake Form Medicare Private Contract New Patient Cancellation Policy New Patient Letter and Office Policies New Patient Supplement List Newsletter Form Notice of Privacy Practices PATIENT ENROLLMENT AND CONSENT FORM Physician's Records Request List

Insurance Policy

Insurance Policy

Dr. Ann Shippy is an Out-of-Network provider. All office visits are paid for at the time of your visit. Our office does not bill the insurance company. But because Dr. Shippy is a licensed physician, your office visits may be covered under your policy as an Out of Network visit. Please check with your insurance company for your individual coverage for Out of Network, we do not have that information, nor do we have access to it.

We will provide you with a receipt that you may submit to your insurance company for reimbursement based on your Out of Network coverage. However, because Dr. Shippy is practicing Internal Medicine and Functional Medicine some insurance companies view her practice as experimental/investigational and as such are not eligible for reimbursement.

Dr. Ann Shippy is not a Medicare Provider. No claims can be made to Medicare for your office visits with them. You will need to sign a private contract with them if you are enrolled under Medicare prior to your office visit. Please let us know if you are enrolled in Medicare prior so we can provide this contract for you.

Because we do not file insurance in this office, we do not have an insurance specialist to handle problems that may arise with your policy. In case of a denial of your claim(s), we will work with you to try and get it resolved, but you are responsible to find out from your insurance company what it is they need and convey that information to us.

However, sometimes the insurance company requests that Dr. Shippy provide information outside of the normal notes that they take during your office visit. If this happens and you wish for Dr. Shippy to provide additional information, you may be billed at Dr. Shippy's current hourly rate for the administrative time that it takes for her to provide the requested information to your insurance provider. In some cases the insurance company will pay their fee, but we cannot guarantee this. We will notify you if we receive such a request in order to get permission to proceed with this process and to charge you for Dr. Shippy's time.

Please sign and date as acknowledgement that you understand and agree to the terms of this Insurance Policy

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