Billing, Insurance, Referral, Results, Refills and Record Information

Billing

Billing Department

Phone (586) 498-5160
Fax      (586) 498-5199

• Co-Pays and Non-Covered Services.

Co-pays and charges for non-insurance covered services are due on the appointment date. We will collect your co-pay prior to your visit. Failure to pay this may result in a rescheduling of your appointment. You have a contractual obligation to pay your co-pay at the time services are rendered.

Cash, Check, Visa, Mastercard and Discover are accepted.

Failure to pay bills in a timely fashion may result in dismissal from the practice and the balance owed turned over to a collection agency.

 

Insurance

We are providers for many insurance companies. Each insurance company has many different coverage plans. Only your insurance carrier or employee benefits office can provide you with the most accurate information to prevent unexpected costs.

Please check with your insurance carrier or employee benefits office, prior to your appointment, to determine medical services covered under your insurance plan. Services not covered may include:  Nutrition Consults, Physicals, Infertility, Cosmetic procedures, Immunizations, Injections, Breathing Treatments and in-office Lab testing, such as Strep Screens. Some plans have a yearly maximum; you are responsible for amounts over the maximum.

Insurance coverage is a contract between you and your insurance company.   We participate with many insurance companies. Each company has different contracts with specific benefits and restrictions. You need to be aware of your coverage, benefits and limitations, including co-pays and deductibles.

• Insurance Cards

Please notify the reception staff of insurance changes and new cards.

All current, valid insurance cards must be shown to the front desk staff at each visit.  Presenting all current cards will help ensure that charges are directed to the insurance carrier, and not billed to you.

• Address and Phone number changes

Notify the reception staff of address and phone number changes.

 

HMO and Manage Care Referrals

HMO's and Managed Care plans require referrals for all services outside of our offices except yearly gyn care.  FAILURE TO OBTAIN A REFERRAL PRIOR TO A SPECIALIST VISIT MAY RESULT IN SIGNIFICANT COST TO YOU. REFERRALS AFTER THE VISIT (RETRO-REFERRALS) WILL NOT BE ISSUED.

Patients must be seen by one of our caregivers before a referral to a specialist is made. Your primary care provider will assess your symptoms and condition to decide the best treatment plan.

Patients are referred within the St. John Physician Network, unless insurance dictates otherwise or the specialty is not available in the network.

Approved referrals are ready in 1 week.  The referral will be faxed to the specialist.  Call 2 business days prior to your appointment to verify that your referral was sent. Contact our referral representative as soon as possible prior to services, for authorization. Remember to leave the specialist name, the appointment time and date on the referral voicemail.

 

Test Results

You will be contacted by mail or phone with your results. You may be asked to make a return appointment to review results if they require a lengthy explanation or further treatment.

 

Medication Refills

Please phone the office and select the refill line prompt. We will attempt to process refills within two business days. Some refills may be phoned to your pharmacy; others must be picked up from the office. Please leave a pharmacy number for call-in prescriptions.

If you are overdue for a follow-up appointment, we may refuse to refill prescriptions until you are seen.  PLEASE DO NOT USE THE AFTER HOURS EMERGENCY NUMBER FOR PRESCRIPTION REFILLS.

 

Records Release Requests

There is a $20 charge for record requests. This does not include records sent with you for a specialty consult.