There are many questions and misunderstandings regarding medical insurance coverage and terminologies used, in an ever-changing industry. There was a time when you paid your premiums through your employer group, had a very minimum co-payment of $5 or $10, and the insurance company would pay everything else. Unfortunately, that is not the case any longer. Below you will find information that we hope will assist you in understanding your insurance coverage:
Our office will bill your insurance company for all of the services provided to you (office visits, surgeries, procedures, etc.). Reimbursement from your insurance to our office is based on our contractual agreement and our participation status. Your benefit plan will determine your responsibilities for several types of payments. Included:
Copayment: A fixed amount that your insurance company may require you to pay to the physician at the time of service. A copayment may be due for each visit, depending on the type of service you require.
Deductible: The amount you are responsible to pay for Medical services rendered, before coverage begins, each plan year. Some insurance carriers have individual deductibles, and/or family deductibles, which are required before they will make payment for eligible benefits.
Coinsurance: After your deductible has been satisfied, your insurance company will pay a percentage of the eligible amount of charges for services. You could be responsible for the remaining percentage of expenses beyond the deductible (up to a maximum). The percentage is determined by your benefit plan structure with your insurance company.
The terms under which insurance policies establish these limitations on reimbursement vary widely among policies and depend on your individual contract and benefit plan.
As the patient, it is your responsibility to know your insurance policy and benefits. We strongly encourage you to contact your insurance company to verify your plan benefits (copayments, deductible, and/or coinsurance). Co-payments, deductibles, coinsurance and non-covered services are the member’s responsibility, and will be collected up front.
IT IS OUR OFFICE POLICY TO COLLECT YOUR COPAYMENT AT THE TIME OF SERVICE, WHEN YOU CHECK IN FOR YOUR APPOINTMENT. WE WILL ALSO COLLECT A FULL OR PARTIAL PAYMENT FOR YOUR OFFICE VISIT, PROCEDURE(S) AND/OR SURGERY, IF YOUR DEDUCTIBLE AND/OR COINSURANCE HAS NOT BEEN MET (unless other payment arrangements have been approved by our office).
*All of our physicians are also members of the MACIPA network (Mt. Auburn Cambridge Independent Practice Association)*