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Practice Information


Insurance and Billing

Our Policies and Accepted Plans

Insurance plans that we accept:*
Aetna PPO, HMO, POS, EPO
Blue Cross / Blue Shield PPO, Blue Choice POS
Beech Street PPO
Cigna PPO, HMO, POS, EPO
Cofinity/PPOM
ElmhurstMemorial Healthcare PPO
Great West PPO, HMO, POS
HFN
Humana PPO, POS
Interplan PPO
Medicare
Multiplan PPO
NPPN (PlanCare America) PPO
PHCS PPO
PNA PPO
Unicare PPO
United Heath Care PPO

*Subject to change - It is the responsibility of the patient to verify participation with their insurance carrier prior to first appointment.


Financial Policy

We feel that it is important to clearly communicate to our patients both our treatment plan and our financial policies.

Please read carefully.

1. Insurance: We are in network with most PPO plans and we accept Medicare assignment.   As a courtesy to you, we will file claims with your insurance company and you agree to authorize payments directly to Spine & Sports Physiatrists.
  • You understand that as the policyholder or covered dependent, it is your responsibility to know your company’s benefits, requirements and exclusions for treatment.
  • You understand that regardless of your insurance coverage, you are responsible for any and all fees incurred during treatment.
  • While we are happy to file claims with your insurance company as a courtesy to you, this office cannot accept responsibility for collecting your insurance claim for you or negotiating settlement for you on a disputed claim.  Your coverage is a contract between you and your insurance company.
  • Bills not paid by your insurance company will be turned over to your responsibility.  
2. Payment:
  • Our office requires a credit card on file for payment of any co-insurance or deductible amounts as required per the EOB from your insurance. If you do not have a credit card or do not want to have your number on file, you will be required to give your social security number.  See our Credit Card FAQ (below) for more details.
  • Co-Pays:  Co-pays and any balances from previous visits are due at the time of service.  You will be asked to reschedule your appointment if you are unprepared to pay either the co-pay or previous balance amount at the time of service.
  • If you are unable to pay the full amount of a large bill, you agree to contact our biller to set up a monthly payment plan and authorize us to charge your credit card for the monthly amount.
  • Unpaid bills will be turned over to an outside collection agency after 90 days.  You agree to pay any additional collection fees, court costs, and attorney fees required by the outside collection agency.  If the phone number(s) your are  providing include your cell number, you consent to receiving auto-dialed or prerecorded message calls from our outside collection agency who may call when attempting to collect on an past due amounts.
3. Timely Payment Discount: We offer a 30% discount for patients who pay their full bill at the time of service. With this discount self-pay patients can get a rate that is comparable to the insurance company rates.  

4. Other Fees:  We never charge a facility fee!  The following fees may apply.
  • Missed Appointments:  A $25 fee for missed appointments or appointments that are cancelled/rescheduled within 24 hours of the appointment time will be applied.  This fee will be charged to your credit card on file.  This fee is the responsibility of the patient and will not be covered by insurance. Furthermore, our policy is to discharge patients on the third missed appointment.
  • Miscellaneous Form Fee (i.e. for forms required by your disability insurance or employer):  We are glad to print a copy of your medical records and attach it to your form free of charge.  For forms that must be filled out, we charge $10 per page and this fee must be paid in advance.  
5. Workers Compensation (WC) Injuries: Our practice is very experienced in treating work injuries and has an excellent track record in getting people back to work.  If you are injured at work, your employer’s WC insurance company must be billed since your personal health insurance plan is not responsible.  To process your WC claim we will need the name of the WC insurance, your claim number, date of injury, and adjuster’s information.

6. Motor Vehicle Accidents (MVA): Our practice has been treating MVA injuries for over 15 years and we welcome MVA patients.  However, your personal health insurance will not cover these injuries.  Due to the lawsuits that often accompany MVAs and the complexities of billing third party auto insurance, all MVA visits must be self-pay.  We will provide you with any documentation you need to submit claims to your insurance company.  We also offer a timely-payment discount (see above) that can significantly lower your out-of-pocket expense and allow you to keep more of your insurance/settlement money in the long run.

Credit Card on File FAQs


Why is Spine & Sports Physiatrists requiring a credit card agreement from patients?
This practice will improve efficiency for everyone and lower the total cost of providing service to our patients.  It will also allow us to focus our time and energy our providing patient care rather than patient billing.

Will my credit card number be secure?
Yes, we will enter your number into an electronic “vault” provided by our credit card processor.  Once your number is entered, we will no longer be able to see the numbers.  We will shred the paper form with your number.    

When will my credit card be charged?
As a courtesy to our patients, we submit claims to your insurance within a few days of providing the patient service.  Claims are typically settled by insurance companies within 2-8 weeks after service was provided.  Once a claim is adjudicated, your card will be charged.  Any remaining balance after insurance pays that is less than $250 will be charged to the authorized card.  Monthly increments of $250 will be charged for any larger balances until the account is paid in full.  We may also charge your credit card for $25 for missed appointments or appointments canceled/rescheduled with less than 24 hours notice..  

How will I know how much the charge for my office visit will be?  
Insurance companies send an Explanation of Benefits (EOB) to both the patient and the provider after claims have been settled that explains the contracted fees agreed between our office and the insurance.  The EOB also shows whether any of the agreed upon fee must be paid by patient in the form of co-pay, co-insurance, or deductible.  At that time, any patient balance is due in full.  

What if I do not agree with the patient portion as specified by my insurance?
As the customer of the insurance company, patients can exercise procedures with their insurance for handling disputes as to whether the insurance company or the patient is responsible for a particular fee.  These procedures are typically regulated by state governments.  The patient is ultimately responsible for the cost of the service provided, up to the amount allowed by the insurance plan that our office accepts.  We are not a party to disputes involving what portion of payment is the patient’s versus the insurance company’s.  Nonetheless, we will provide our expertise to you as a resource to help facilitate understanding of what your insurance company communicates to you about your contract.

What if I still do not agree with the charge applied to my card?
Our biller will review each patient’s situation before applying a charge.  In the event of any question or issue, please do not hesitate to contact our biller or office manager and we will work to resolve it as quickly as possible. As a last resort, you should rest assured that credit card companies typically have procedures for a cardholder to dispute a charge applied by any merchant.  Credit card companies can suspend or reverse a charge if they determine it was not appropriate.

What if I don’t have a credit card or do not want to participate?  Is this mandatory?
Either your social security number or credit card on file is required to avoid any financial issues.