FINANCIAL POLICY
As an Orthopaedic practice and medical office, our relationship is with you, not your insurance company. While the filing of insurance claims is a courtesy that we extend to our patients, all charges are the patient/guarantor’s responsibility for the services rendered. We can assist in determining your plan benefits and coverage, but it is ultimately your responsibility to know and understand the services covered by your health insurance plan. Please inquire and explore your benefits with your insurance carrier if you are unsure of your plan’s orthopaedic/specialist benefits. It is also your responsibility to notify us if your insurance carrier or policy changes.
We are happy to discuss our charges and provide you with an estimate of charges for your visit(s) or surgery, upon request. These requests must be made in advance to provide an accurate estimate of our services. These estimates do not include the hospital’s charges for the surgery. Patients will need to contact the billing department of the facility that surgery is scheduled for those costs.
OUTSTANDING BALANCES
All outstanding patient balances 45 days or older must be paid or have a payment plan on file by contacting the billing department. No additional appointments will be scheduled until payment arrangements have been made or paid in full for patients in a pre-collections or collection status.
PATIENTS WITH IN-NETWORK INSURANCE COVERAGE
Clinic Visits and Surgery Charges - For patients who have in-network insurance plan coverage, MOGL will bill the insurance carrier for the services provided. Per our contractual obligation with your insurance provider, Patients are responsible for co-pays, deductibles, coinsurance balances, and any known services not covered by your insurance, at the time of the clinic appointment or once a statement is received. Your insurance company requires that we collect your co-pay at check-in. Co-pays are separate from your deductible and are still required for some plans upon meeting your deductible. There may be a balance after the insurance carrier has settled their part of the claim for services other than the office visits, including: x-rays, injections, DME, etc. The patient will be billed for this balance once insurance has paid their portion.
PATIENTS WITH NON-CONTRACTED INSURANCE PLAN COVERAGE
If we are not contracted or are out-of-network with the insured’s policy, as a courtesy, MOGL will bill the insurance carrier for the services provided. However, any outstanding balances are the patient’s responsibility. Insurance companies sometimes use the phrase “usual and customary” or “out of network” when discussing our fees. Insurance companies set their own “usual and customary” rates based on a wide geographic area and the fees we charge may differ.
COORDINATION OF BENEFITS
Insurance companies may notify patients that further information is needed to process their claims. Patients need to complete this quick phone call to their insurance company, answering the required questions related to their care and whether or not another party is responsible for payment. If this is not completed, the claim will be denied and the patient is responsible for the full balance. MOGL cannot complete this for patients.
SELF-PAY/UNINSURED PATIENTS
Clinic Visits - Patients who are self-pay (no billable insurance or non-covered services), are required to pay for their visit or services at the time of the appointment. You will be billed for additional charges or other services received during your visit. Payment Plans are available by contacting our Billing Department.
Surgery Charges - A deposit of 50% of the anticipated physician and physician’s assistant fee is required at the time surgery is scheduled. The balance is due at the first post-operative appointment. A payment plan may be approved for the remainder of the amount due.
MINORS OF DIVORCED PARENTS
Both parents are financially responsible for care rendered to minor children. The parent that is listed as the Guarantor for the child will be financially responsible and any statements will be mailed directly to that parent.
SURGERY/GLOBAL SURGICAL PACKAGE
Medical billing for all major surgical procedures (i.e. fracture repair, joint replacement, etc.) generally involves a set fee for the procedure and follow up visits for a period of 90 days following treatment. This is commonly referred to as a “Global Surgical Package” and does not include the initial consultation or evaluation by the surgeon to determine the need for major surgery; visits unrelated to the diagnosis for which the surgical procedure is performed; diagnostic tests and procedures including: x-rays; treatment for post-op complications that require additional operations; additional cast applications and supplies; any braces or splints that may be required; or a more extensive procedure if the less extensive procedure fails.
BILLING STATEMENTS and METHODS OF PAYMENTS.
Patients will receive a text and email link from paymydoctor.com once their claim is processed and a balance is due on their account. You will not receive a paper statement unless you reply STOP to the text that notifies you of your balance. The billing department cannot change this setting for you. We do not suggest paying via the insurance portals for the amounts listed on the EOBs from the insurance company as this may not be the accurate amount owed.
MOGL accepts cash, local checks, debit cards, HSA cards; and all Visa, MasterCard, Discover, and American Express Credit Cards that are accepted in the U.S.
We realize that temporary financial problems may affect timely payment of your account and if such problems do arise, we encourage you to contact our Billing Office for assistance in the management of your account.
REFUNDS
If you are owed a refund and have paid by Credit/Debit card, these will be issued back to the card payment was made from. If a payment was made by cash or check, we will send a check to you in the mail.
If you have questions about any of these payment policies, please ask to speak to someone in our Billing Office or call 414-765-0012.
