David Schechter, M.D. Family Medicine/Sports Medicine
Use of Health Insurance in Our Office
Full name: First Last
1) The coverage and terms of Health Insurance plans vary greatly.
2) If you choose to use health insurance, the rates the insurance company may pay and that you may owe are determined by contracts between the physician and the insurance company and the contracts between you and your insurance company.
3) Sometimes you owe only a copayment. A copayment is a fixed amount defined in your insurance agreement and which you pay the medical provider at the time of service. Do you know your copayment for physicians?
4) Sometimes you may owe a coinsurance amount according to your health insurance agreement. This amount usually is a percentage of the covered amount determined by your insurance company. Does your insurance plan have coinsurance?
5) Sometimes you may owe an amount that the insurance company has applied to your annual insurance deductible. The deductible is the amount you pay medical providers for services before your insurance company will pay. Once the annual deductible is fully met, the insurance company will pay providers and apply a portion of covered amounts to coinsurance. Do you know your annual deductible? Is it individual or family? Are office visits exempt from the deductible or applied to it?
6) If you owe an amount applied to your deductible, our staff can typically determine the amount you owe at the time of your visit, and we expect you to pay that amount.
7) This is also true of the copay or coinsurance.
8) Occasionally the deductible amount estimated is incorrect. For example, your insurance company may process another claim right after it tells us your deductible status and before it processes our claim. If this happens, the insurance company will apply that other claim to the deductible before it processes our claim. Our billing service submits claims within a week or less, so this doesn?t happen often. If it does happen and results in an overpayment to us, we promise to apply any credit balance at your next visit or refund the overpayment to you if you prefer.
9) Sometimes you owe more than you expected to pay. Patients have stated, ?but I paid $100 five years ago and now it?s $300, why is that?? There could be multiple reasons. Five years ago, your deductible may have been smaller. Five years ago, a different service or level of service may have been provided. You may have had a different insurance carrier. The contracted rate may have changed during that time.
10) We try to be extremely fair and accurate with what you owe our office. Our ability to provide services to patients depends on paying the lease, staff salaries, insurance, and many other expenses. Your payment at the time of service ensures we can continue to be here when you need us.
By signing below, I acknowledge that I have read and understand the above. I understand that ultimately, I am responsible for payment for medical services rendered in this office. This is a ?prompt payment? office.
Today's date
