Insurance
& Financial Q & A
Why These
Q & A?
The
insurance staff at SRMS is commonly asked the questions
included on this page. We thought it would be helpful
to place the answers here on the web. If you have other
questions that you would like answered, please give
us a call and we will be more than happy to assist.
What Insurance
Companies Does SRMS Participate With?
We participate in a variety
of managed care programs
Accountable/Interplan,
Aetna, Beechstreet, Blue Shield, Cigna, First Health/Coventry,
GreatWest Healthcare, Multiplan, NPPN, PPO Next/Healthstar,
Self-Insured Benefits Admin. (SIBA), Self-Insured
Plans (SIP*Specific Employment Groups Only), Web
TPA, and Wellcare Healthy Kids
Understand, however;
we simply cannot participate with all carriers. It
is also quite possible that the above listing may
not be entirely accurate as contracts may have changed
before the web site has been updated. If you have
any questions regarding our current participation
with your plan, I suggest that you contact the practice
office at (239) 275-8118.
How Do I Find
Out If Infertility Benefits Are Included On My Policy?
We ask that you take a pro-active
approach to your infertility questions and subsequent
care. Contact your carrier and educate yourself on your
plan coverage. We will call your insurance carrier prior
to your appointment to verify your benefits. We ask
specifically what procedures are and are not covered.
Make certain that you have received a copy of your insurance
plan with the listed benefits from your carrier or employer.
While we do our best to obtain some of this same information,
you will ultimately be responsible for services not
covered on your plan.
It
is strongly recommended that you do the following:
- Review the provided insurance
list (above) to determine whether we are participating
providers for your plan.
- Call the benefits number on
your insurance card to verify what are and what
are not covered services (see below).
- Request that the insurance
company sends you documentation regarding covered
services for infertility under your particular
plan.
- When speaking to an insurance
company, it is best that you obtain everything
in writing. Please also keep a log of your phone
calls and be certain to get the names of the individuals
you speak to when obtaining any insurance information.
It is a lot of work but well worth the effort
when problems occur (and you are almost guaranteed
that they will...).
- Ask your insurance company
what procedures will require pre-certification
(primarily diagnostic procedures and surgeries).
- Be aware of what co-pays,
deductibles or co-insurances that you will be
responsible for.
- Find out what laboratory facilities
your insurance company wants you to use so that
you can obtain maximum financial reimbursement.
SRMS will try to send your laboratory work to
these laboratories to minimize the “out-of-pocket”
expenses you may incur.
There are a couple
of methods you can use to find out what the covered
services are on your plan:
- Consider calling your insurance
company and say that you are "Jane"
or "John Doe." Let them know that you
are currently thinking about working for a business
(your current business) and that your physician
said that you would need XXX procedures. Ask them
if the plan covered by your potential (current)
employer covers such services
- Understand that the insurance
carrier may be hesitant to commit to covering
certain procedures, but they should be able to
tell you what items are definitely not covered
on the plan.
It is unfortunate
that you have to consider such tactics, but the insurance
industry requires imaginative procedures to protect
your individual rights. By using this method, you
will not "red-flag" your policy/chart.
What
Insurance Plans Cover Insemination and IVF Procedures?
All insurance plans vary depending
on what particular plan your employer purchases. Understand
that a particular insurance company may cover IVF, but
that your employer may have decided to not purchase
that particular plan. If you want something covered,
discuss the concerns with your employer.
There are other
plans out there that carry benefits for your services
provided at SRMS. If you are unsure, again, we urge
you to take a pro-active approach to your healthcare
and educate yourself on what your plan covers in detail.
Our approach to your insurance company should just
then be confirming what you already have knowledge
of.
Aetna
currently has an infertility program that covers
everything leading up to and including artificial
insemination. For more information you can call
1-800-575-5999.
Blue Cross Blue Shield
has a plan that covers IVF. For more information
call 1-800-348-7921.
Cigna has
a plan that covers artificial insemination and
IVF. For more information call 1-800-877-1209.
United
Healthcare also has plans that cover
infertility treatment. They may be contacted
at 1-877-842-3210.
If
We Do Not Have Infertility Insurance Benefits, Will
Our First Visit Be Covered?
The staff at SRMS understands that many insurance
carriers do not currently have infertility benefits.
Whenever possible, we will code for the many diseases
that cause infertility. We will use the infertility
diagnosis when necessary. We use imaginative, but
ethical coding.
What Are We Responsible
For If SRMS Does Not Participate In Our Insurance
Plan?
If we don’t participate with your insurance
company, you will be responsible for payment at the
time of service. We will provide you with a receipt
of payment, which you may then submit to your carrier
for direct reimbursement.
What Are The Patient’s
Responsibilities And What Forms Of Payment Are Accepted?
It is your responsibility to determine if SRMS is
on your plan and where any lab tests must be sent
in order for you to receive the maximum reimbursement
allowed under your insurance plan. This information
must be obtained before your first visit. It is also
in your best interest for you to notify us of any
changes in your insurance plan or you may be asked
to reschedule your appointment to ensure that we can
obtain proper benefit information. Co-payments or
deductibles may be requested depending upon your particular
Cash, checks and major
credit cards are accepted as payment for any services
not covered by your insurance. We will ask that you
keep a credit card on file here at the office to pay
for items that are not covered via an automatic payment
method that helps to reduce costs for SRMS and reduce
late fees that may accrue on overdue balances.
We encourage you to ask any questions of the front office
staff regarding fees before the procedures take place.
We attempt to code the medical diseases that bring you
to the facility whenever possible to maximize your insurance
reimbursement.
What
If I Already Know My Care Plan Participates?
If yours is one of the care plans with which we participate,
SRMS will assist you in obtaining the appropriate authorizations
and determine which services will be covered under your
plan.
It will be your responsibility; however, to make certain
that subsequent visits are cleared by the "gatekeeper,"
when this is required by your plan.
If you are member of a managed care plan in which we
participate, but your treatments are not covered under
your plan, pre-payment may be requested prior to the
visit.
What If SRMS Does Not Participate In My Plan or I Do
Not Have Insurance?
If yours is a plan in which we are not currently participating,
or if you do not have insurance coverage, please remember
that payment is expected at the time the service is
provided. If we do not participate with your plan and
your referring physician feels that it is absolutely
necessary to be seen by a reproductive endocrinologist,
and you have no reproductive endocrinologist on your
plan, you might consider petitioning your insurance
plan for appropriate coverage. Many patients have been
successful with this process.
What Fees Should I Expect?
We suggest that fees for surgical procedures
be discussed well in advance of the surgery. A deposit
may be required by your pre-operative visit. This deposit
will be for any surgical co-insurance that your plan
may require for your procedure as well as any non-covered
procedure to be performed. The hospital will collect
any unpaid deductible on your plan prior to surgery.
As a service to our patients, SRMS will file your health
claim to your insurance. If there should be any funds
remaining once payment from your carrier has been received,
you will be sent the difference.
Some laboratory tests will be processed by outside labs.
In these cases, you will generally receive separate
statements from those facilities. If you have any questions
regarding these charges, please contact the lab(s) directly.
Due to quality assurance and the necessity of obtaining
endocrine laboratory studies within a reasonable amount
of time such that important clinical decisions can be
made, we may request that some labs be performed by
our in-office facility. The turn-around time in our
facility is hours instead of days as in the outside
facilities.
Additional fees are generally charged for extensive
records reviews, as well as for off-hour, weekend, holiday
and emergency room visits. Some of these fees may not
be covered by your insurance and will be billed to you
at the time the service is rendered.
SRMS reserves the right to request reimbursement for
expensive copying of records, and the creation of detailed
legal reports and insurance letters.
Are
Loans Available?
The staff at SRMS feels that
your financial well-being is very important. We have
taken the time to research the various options available
to couples in similar situations to yours. Working
with your personal bank is a great way to start the
process. Home equity loans may be the least expensive
loans to obtain and service.
With your best interests in mind, we have teamed up
with Credit Funders to offer you affordable financial
assistance. They provide high approval rates and flexible payment options. To learn moreand to complete the application, please download the brochure containing the application and fax it back to the our office for review and submission.
Who Is Responsible For My Bill?
It is understood that the professional
services offered by our physician are provided to
you, the patient. Therefore, the payment of the bill
is your direct responsibility, even if you are having
a dispute with your insurance company. Please understand
that although we strive to obtain the most accurate
information from your insurance company, sometimes
even they can quote incorrect benefits. Their own
disclaimer states that the "quote of benefits
is not a guarantee of coverage".
It is our policy to charge reasonable fees on balances
which are 30 days past due.
Please
feel free to discuss our fees at any time. We realize
that the expense involved in the diagnosis and treatment
can sometimes be significant, and we are sensitive to
your concerns.
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