Your Insurance Company and Our Office

What you need to know about getting your healthcare services paid

Non-Covered Services are Your Responsibility

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.

Our Financial Policy

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. We will provide you with the necessary information for you to submit to your insurance company for reimbursement.

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. We accept cash, in-state personal checks, 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.

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, that 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.

Medicare generally does not pay for physicals at all except for a gyn physical with PAP every two years. However, starting in 2005 new Medicare beneficiaries are entitled to a Welcome Physical and EKG, if done within 6 months of registration.

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:

Pam Harding

Brattleboro Primary Care

21 Belmont Avenue

Brattleboro, Vermont 05301

802-258-3905

Our Billing Office is located at:

Primary Care Health Partners

Suite 2161

145 Pine Haven Shore Road

Shelburne, VT 05482

Phone: 802-846-3090 or 877-876-2817

Fax: 802-846-3097

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	Home
	Home		Your Insurance Company and Our Office What you need to know about getting your healthcare services paid Non-Covered Services are Your Responsibility 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. Our Financial Policy 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. We will provide you with the necessary information for you to submit to your insurance company for reimbursement. 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. We accept cash, in-state personal checks, 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. 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, that 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. Medicare generally does not pay for physicals at all except for a gyn physical with PAP every two years. However, starting in 2005 new Medicare beneficiaries are entitled to a Welcome Physical and EKG, if done within 6 months of registration. 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: Pam Harding Brattleboro Primary Care 21 Belmont Avenue Brattleboro, Vermont 05301 802-258-3905 Our Billing Office is located at: Primary Care Health Partners Suite 2161 145 Pine Haven Shore Road Shelburne, VT 05482 Phone: 802-846-3090 or 877-876-2817 Fax: 802-846-3097 Back