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Financial Policy & Agreement
Thank you for selecting Lexington OB/GYN as your healthcare provider. Our commitment is to provide the very best healthcare to our patients while recognizing the need to limit services to only those medically necessary. The responsibility for payment of fees for these services is the direct obligation of the patient. Any financial payment you may receive from private insurance or government agencies is a matter strictly between you and the insurance carrier or government agency.
You must realize that your health benefit plan is an arrangement between you, the enrollee and the insurance company, HMO or your employer. While we will try to be helpful, and we may participate in the plan, your health benefit plan determines your coverage, any requirements for prior authorizations or referrals and establishes the limit on your coverage for medical services. We cannot know the benefits and exclusions of each patient’s policy. It is the patient’s responsibility to know and understand her coverage and benefits.
For insurance plans we participate with, we will seek to obtain verification of your eligibility, however, even when such eligibility and/or benefits are verified, your insurance plan will not guarantee the accuracy of their confirmation of coverage or benefits, and that you are eligible and that your benefits are in force. Therefore, it is our policy to obtain your credit card number and authorization to assume acceptance of financial responsibility, should your insurance plan not honor the claim we submit for the services we provide to you.
Billing your Insurance Carrier:
This practice will invoice you or your insurer. If a bill, not disputed by the guarantor of the bill, patient or by the insurer in accordance with New York State (NYS) regulation, and is not paid with 45 days, we will transfer the balance to your responsibility. Please be advised that in NYS a health insurer is required by regulation to pay its claims within 45 days, therefore, should your insurer fail to do so, they are in violation of the regulations of the State of New York, and you should contact the NYS Department of Insurance, as you may have a recourse against your insurer for their failure.
Billing Information:
Please be sure that we have your most current demographic and insurance information at all times. It is your responsibility to provide us with this information. As soon as your information changes, notify us in writing immediately, so we can make the appropriate changes in our billing system and continue your care. You will be responsible for any charges billed to the wrong insurance carrier as a result of not providing us with correct insurance information and we will not re-file a claim to the correct insurance after 30 days of the service date.
Well Women (Preventive) and Problem Focused exams:
A well women exam is when a healthy patient is seen to screen for various illnesses and diseases; this is considered preventive medicine. A problem visit is one where the patient has a specific concern, symptom or complaint. We are required to submit claims based on the services you receive. If we provide both a well women and a problem focused exam then both services may be billed. Depending on your insurance coverage, some or all of the cost may have to be billed to the patient. We recommend you contact your insurance carrier prior to each visit and inquire about the type of benefits you have. Once a claim has been submitted to your insurance carrier, the office will not change the coding in order to circumvent an insurance denial as this may be considered insurance fraud.
Referrals/Authorizations:
Should your insurance carrier require a referral or authorization, it is your responsibility to obtain or request one prior to your appointment. Please note some insurance carriers will not allow your OB/GYN physician to issue a referral. In this case, you will need to consult your primary care physician (PCP). The office will not issue referrals or authorizations for services already performed.
Bills from Laboratories, Hospitals and Other Healthcare Providers:
If your medical care requires a pap smear, blood work, a culture or a biopsy, the specimen is generally sent to an outside laboratory or hospital for analysis. When this occurs you may receive a separate bill from that laboratory. If you receive medical care during a hospital inpatient or outpatient encounter, you may receive separate bills from the hospital, the anesthesia department and other healthcare providers involved in your care. Any questions related to these bills cannot be answered by this office and will need to be directed to the billing entity.
Telephone consultations:
Your insurance benefits do not include telephone consultations as a covered benefit. A telephone consultation is a request by the patient for clinical advice related to a new or distinct medical condition and is not part of the follow up to a condition under active treatment in the office. Telephone consultation are also charged if the patient requests and authorizes a discussion of the patients condition, treatment, or any other clinical matter with a relative or other physician not part of the active treatment of the patient. No charges are incurred in our response to follow up questions to the office visit or to discuss lab results.
Form Completion:
Should you require specialized forms for employment, school, disability, or for any other purpose, you must assume the cost of preparing these forms. Should you request that this office discuss the contents of any form, a telephone consultation charge will be required. The patient must authorize such communications in writing. Forms requested for completion must be provided at least 1 week before the due date. The charge for basic form completion is $25.00. This charge will change based on the complexity and time involved.
Returned Checks:
If you make a payment by check to the office and it is returned to us for any reason, you will incur a fee of $35.00. Additionally, no appointments or services will be provided for non-emergent care, until the balance is paid in full.
Appointment Cancelation, No show and Rescheduling Policy:
Any appointments for New GYN patients, Initial Obstetrical patients and office procedures that are not cancelled by 10:00am two (2) business days in advance will result in a $100.00 charge billed to your account. Any appointments for follow up GYN visits or obstetrical rechecks that are not cancelled by 10:00am two (2) business days in advance will result in a $50.00 charge billed to your account. Any cancellation or rescheduling of a scheduled surgical procedure without a valid medical reason will incur a $200.00 cancellation fee. Cancelation fees are not covered by insurance.
Copayments:
Copayments are contractual obligations between you and your insurance carrier. Compliance rules set forth by federal and state governments require us to collect copayments. All patients are expected to pay their copayments at the time of the visit. If you fail to pay your copayment you will be assessed a $25.00 processing fee.
Non-covered charges:
A non-covered service is any service that is denied by your insurance carrier due to benefit descriptions or limitations, policy exclusions, or pre-existing waiting periods. Non-covered services will be the responsibility of the patient and payment is due at the time of service.
Replacement Prescriptions:
This practice provides prescriptions that are medically necessary and appropriate in your treatment. If you are on a long-term medication, our physicians will typically prescribe a sufficient quantity to last until your next visit. If you are running out of medicine, it is likely because you need to make a follow-up appointment. It is your responsibility to promptly fill the prescription. Should the prescription become lost, or you have moved to a new pharmacy, and a replacement is necessary, there is a $25 fee that must be paid before the replacement prescription is provided.
Rebilling Fees:
Your insurance carrier will notify both you and our office with an Explanation of Benefits (EOB) if there is a balance due that is your responsibility. At that time a statement will be sent to you. If the balance is not settled in full within 30 days, or arrangements to settle the balance have not been set up with our financial department, a $10.00 rebilling fee will be incurred. Additional $10.00 rebilling fees will be incurred for each 30 day period that the balance remains unpaid.
Past due accounts:
It is our intention to maintain all patient accounts in our office. However, if your account becomes past due the office will take the necessary steps to collect this debt. We have the options of sending your account to a collection agency or to an attorney, reporting your account to a credit reporting agency or submitting a claim to the appropriate court. In the event your account is turned over to our Collection Agency, you will be responsible for all collection fees (33% will be added to your account balance) and all legal fees (court costs will be added to your balance) that our office incurs through the process utilized to collect the outstanding delinquent balance.
* The fees/charges quoted above are subject to change at any time.
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