Office Visit Cost and Billing Information
We Expect Payment At The Time Of Service
As a courtesy we will bill insurance companies with whom we have a contract for your office visit. We must have registration paperwork completed and on file along with a front and back copy of your insurance card to be able to bill for your visit.
If you have a large deductible and you have not completely met your responsibility for that deductible we will require payment for your service at the time of the visit as you are responsible for the cost of your visit along with any lab work or procedures until your deductible is fully met. Please come prepared to pay for these costs AT your visit as you know you are liable for them. If you ask us to bill you for the portion of your remaining deductible that you owe we will add a $45.00 “billing fee” to cover staff costs for those billing services. This fee will be added to your total visit charge. You will be personally responsible for this fee as your insurance will not cover that charge. Any overpayment(s) will be refunded to you.
If we do not have a contract with your carrier and you are “out of network” or you have no healthcare insurance your visit will be Self Pay. We have reasonable cash pay prices. You will be asked to pay for your visit at the time of service. Please come prepared to pay for these charges with cash, checks, or credit cards at the time of your visit. We will provide an itemized receipt for your visit. We will NOT provide a HCFA form as we have provided cash pay discounts to your pricing. The billing computer program contains only insurance pricing.
The lab work ordered for each individual will of course be variable based on their unique history and clinical situation. We will bill contracted insurance carriers only for “standard” blood testing. Saliva testing is not billable. Stool and many urine tests are so poorly reimbursed by insurance that this is often below our charge from the testing laboratory. These are payable at the time of your appointment.
If YOU ask to have lab work performed at an outside lab where your insurance will cover your testing we will add a “Lab Handling Fee” to your visit charges. This fee is payable at the time of your service. Labs drawn in office and performed through our reference lab flow directly into your chart and simplify handling of results. Lab results from outside labs arrive in paper format and staff must manually enter those values into your chart for them to be useful. The “Lab Handling Fee” pays for staff time necessary to manually enter those values into your chart. If WE ask you to have labs performed at an outside lab because the test requires special handling we are unable to do in office, then the outside lab fee does NOT apply.
We will discuss more advanced testing with you. Many of these we will not bill and you will be asked to pay for them at the time of the visit. If we have experience that some are partially covered by insurance we will ask you to sign an ABN or Advanced Beneficiary Notification form. Most insurance carriers are becoming increasingly reluctant to pay for advanced testing not offered by standard laboratories often giving the reason that these tests are experimental, or are simply not covered. The ABN states that you want the test and are willing to pay for it should the insurance not pay for it. It will also list the maximum out of pocket cost you would owe us if your carrier paid nothing. Some carriers will only cover a portion of some specialty testing performed at specialized labs that we may feel is necessary to help diagnose your condition. You will be responsible for paying any cost not paid by your carrier up to the ABN maximum even if your insurance denies payment for the testing, which is the reason for the ABN form.