EHP Financial Policy
Encompass Health’s financial policy goal is to provide you with the highest professional medical care and patient satisfaction. To avoid misunderstandings and ensure timely payment for services, you must understand your financial responsibilities concerning your health care.
We require all patients to sign our Authorization and Consent for Treatment Form before receiving medical services. This form confirms that you understand that the services provided are necessary and appropriate and advises you of your financial responsibility with respect to services received.
Patients or their legal representatives are ultimately responsible for all charges for services provided. We expect your payment at the time of your visit for all charges owed for that visit as well as any prior balance. Some insurance plans tell us precisely what you will owe at your visit; in that case, we may request full payment for your share when you check in or out. Other insurance plans do not provide immediate information regarding patient responsibility; in that case, you will be mailed a statement to settle your account. Timely payment upon receipt of your statement is requested to avoid incurring late fees. Late fees will be charged if payment is not received within 30 days of the statement date. Payment plans are available upon request.
If you have an Annual Wellness Visit or Physical Exam but need additional services, we may bill you for those additional services. All services for patients who are minors will be billed to the custodial parent or legal guardian.
TYPES OF PAYMENTS
1. Co-payments. Insurance carriers require that we collect your co-payment during your visit. You may reschedule your appointment if you are not prepared to make your co-payment.
2. Deductibles. Most insurance plans require you to pay a predetermined amount (the “deductible”) before insurance will cover certain charges. Our technology allows us to view your remaining deductible and help you understand what you will owe for your visit so we can collect the amount due at your visit. For new patients who have not yet met their deductible, we may collect up to $125.00; for established patients, we may collect up to $75.00. This payment will be applied to your visit. When your insurance completes processing your health insurance claim, you may be responsible for an additional amount depending on our contract with your insurer.
3. Co-insurance. Some insurance plans require that you pay a certain percentage (for example, 20%) of the allowable charge amount. Our technology allows us to view the details of your insurance plan, including your coinsurance amount, and calculate the expected out-of-pocket cost for you. If we can determine the amount, we will ask that you pay your co-insurance during your visit.
4. Uninsured Patients / Self-Pay. If you do not have insurance or if your insurance does not cover the services provided, payment for all services is due at the time of your visit. Two options are available: 1) a prompt pay discount if you pay in full at the time of service, or 2) we can bill you if you do not pay at the time of service. If the total charge amount is unavailable at checkout, you may be required to pay a deposit that will be applied to your charges. If the deposit exceeds the actual charges, a refund will be issued.
NOTE: If you take advantage of our Card on File process, you will not be required to pay a deposit at the time of your visit.
Deposit amounts are:
• New patients: total charge or a minimum $200 deposit.
• Established patients: total charge or a minimum $150 deposit.
5. Out-of-Network. We participate with most major insurance plans. Before making your appointment, you can contact your insurance company to confirm if your provider is in-network. If we do not participate in your insurance plan, you will be required to pay for your visit at the time of service. We may send a courtesy bill to your insurance company. If the total charge amount is unavailable at the checkout, you may be required to pay a deposit as described above.
6. Non-Covered Services. You are responsible for contacting your insurance plan to determine whether a particular service is covered. If we provide you with non-covered services, you are expected to pay for the services at the time of your visit. Our billing staff will assist you in attempting to resolve any appeals.
If you are a Medicare patient, we will inform you of any non-covered services before your treatment. Your provider will review options with you and document your decision and acceptance of financial responsibility using the Centers for Medicare and Medicaid Services (CMS) form CMS-R-131 (03/08), Advance Beneficiary Notice (ABN).
We ask all patients to provide their insurance card (if applicable) and proof of identification (such as a photo ID or driver’s license) at every visit. If you do not provide current proof of insurance, you may be billed as an uninsured patient (i.e., self-pay). If you provide your insurance card(s) at a later time, we may be able to retroactively bill the services to your insurer, depending on the insurance plan’s requirements. We accept the assignment of benefits for many third-party carriers, so in most cases, we will submit charges for services rendered to your insurance carrier. You are expected to pay the entire amount determined by your insurance to be the patient’s responsibility. Our fees are for physician services only; you may receive additional bills from the laboratory, radiology, or other diagnostic-related providers.
YOU ARE RESPONSIBLE FOR
- Know if a referral or authorization is necessary for office visits (If it is required and you do not have the appropriate referral or authorization, you may be billed as an uninsured patient).
- Check with your insurance plan to determine if prescribed testing (lab, radiology, etc.) is covered under your insurance policy. (If you choose to have non-covered testing, we will require full payment at your visit.)
- Check with your insurance plan to review the schedule of benefits and whether a co-payment or deductible applies.
- File any appeals with your insurance plan if needed.
- Coordinate benefits if you have more than one insurance plan. You may be required to contact your insurance company to clarify which plan is primary or to correct any demographic or other issues.
- Arrive for appointments with all required documentation.
Insurance Verification. We will attempt to verify your insurance eligibility two (2) business days before your visit. We will contact you about your insurance eligibility if we cannot confirm active insurance coverage. If you cannot present an alternative form of active insurance coverage before the visit, you will be required to either pay at the time of your visit or reschedule your appointment. For same-day appointments, we will check eligibility when the appointment is made.
Outstanding Balances. After your visit, we will send you a statement for any outstanding balances. All outstanding balances are due on receipt. If you come for another visit and have an outstanding balance, we will request payment for the new visit and your outstanding balance.
We generally send statements every twenty-eight (28) days, beginning when the balance becomes the patient’s responsibility. Suppose you have an outstanding balance for more than ninety (90) days. In that case, you may be referred to an outside collection agency and charged a collection fee of $25 or whatever amount is permitted by applicable state law in addition to the balance owed. Also, if you have unpaid delinquent accounts, we may discharge you as a patient, and you may not be allowed to schedule any additional services unless special arrangements have been made.
LATE ARRIVALS, CANCELLATIONS, AND NO-SHOWS
Late arrivals. If you arrive late for a scheduled appointment, you may be asked to reschedule or wait for an open appointment on that day’s schedule. Patients who arrive more than 20 min late may be asked to schedule for a different day. If no notice of late arrival of fewer than 20 minutes is provided, the office will consider this a “no-show,” and the patient will be responsible for the above noted-fees.
Cancellations. If you cannot keep a scheduled appointment, you must call at least one (1) business day in advance, or we may consider you a “no-show.”
No-shows. If you miss your appointment, you will be charged a $75.00 fee for a missed appointment This fee will need to be paid before rescheduling. This fee cannot be billed to insurance. As permitted by state law, you may be discharged as a patient following three (3) no-shows in one year (365 days).
Thank you for helping us run a better practice!