Read about Premier OB/GYN of Manatee’s payment policy below and download a copy of our brochure, which includes our payment policy. If you have anyquestions about insurance coverage or any other topic, please call our office at (941) 745-5115.
Medicare and Medicare Replacements
If you are a Medicare patient, Premier OB/GYN of Manatee, is a Participating Provider. We accept Medicare assignment as well as many Medicare replacements and will submit a claim for your visit.
- Advance Beneficiary Notice: We may be asking you to sign an Advance Beneficiary Notice (ABN) as directed by Medicare for advance notification of your responsibility for any charges not covered by Medicare or your Medicare replacement policy.
- Co-payments/Deductibles/Non-covered Services: Please note that although most Medicare replacement plans follow Medicare guidelines for covered services, they are not all alike in the patient’s payment responsibility. Traditional Medicare may not require a co-pay for a particular service, however many of the new Medicare replacement plans require patient co-pays or co-insurance as well as authorizations for visits and procedures. You’ll need to refer to your particular insurance plan for details or call the customer service or member service number on the back of your card.
Obstetric Patients
Obstetric care is covered under a “global” benefit that covers all your physician’s care for normal routine antepartum visits, delivery and postpartum care. If you are an obstetric patient, we will be reviewing your insurance benefits in detail with you during your first visit as well as explaining what services are covered and not covered under a “global” plan.
Insurance Terms
“Assignment of Benefits” is an arrangement asking your Insurance Company to send your reimbursement directly to your doctor.
“Co-insurance” refers to a sharing of costs between the insurance carrier and the patient. For example, if the coinsurance is 80/20, that means that the insurance carrier is responsible for paying 80% of the contracted fee for service and the patient is responsible for the remaining 20%. This will be indicated on your Explanation of Benefits (EOB) from the insurance company, after they have processed the claim. From this EOB, the physician’s office is notified of patient responsibility and bills you accordingly.
“Co-pay” refers to a fixed dollar amount due for each and every physician’s office visit, unless otherwise specified by your specific contract.
“Deductible” refers to the first portion of care costs incurred during the year. For example, if you have a $300 deductible, it means that your Insurance Company expects you to pay for the first $300 of the care you receive in a given year. After that, they will pay their portion or “co-insurance” for the rest of the care you receive during that year.
“Rebilling Fee” A fixed monthly charge applied to statements that have balances that have not been paid in the past 30 days.
Primary Insurance
If you have medical insurance and we are contracted with your insurance company, as a service to you, we will bill your insurance company directly. We accept assignment of benefits for most major insurance plans including traditional Medicare plans and many Medicare replacement plans. Please be sure to present your insurance card at time of check in.
Secondary Insurance
If you have a secondary insurance, please present the card at the time of your visit. Be sure you have specified which insurance is primary and secondary when you are checking in at the front desk.
In-Network Physicians
Individual plans as well as coverage benefits are constantly changing. It is your responsibility to verify that we are an in-network provider on your specific plan. You check by calling the customer service or member services phone number on the back of your card.
Authorizations
If your insurance requires referrals or authorizations, please call your primary care physician and request that it be faxed to our office at 941-750-6538 by your appointment date. We suggest you call our office prior to your appointment to be sure we have received it. If we have not received it, we will offer to reschedule your appointment. Your insurance will not pay for the visit if you do not have the required authorization or referral and you will be responsible for the charges.
Co-payment/Deductibles/Non-covered Services
At the time of your visit, you will be expected to pay for any copayments, coinsurance and deductibles as outlined by your particular insurance plan, as well as any charges not covered by insurance. If you are unsure what portion is your responsibility, you can call the customer service or member services number on the back of your insurance card.
Self-pay Patients
Self-pay patients are expected to pay at time of service. Any outside services (labs, pathology, etc) will be billed to the patient directly by that facility.
Annual Visits
Unless you are discussing birth control, most insurance plans will not cover an annual visit with a problem visit on the same day. Therefore we suggest that you first make an appointment to discuss any problems you may be experiencing, (vaginal discharge, abdominal pain, heavy, painful periods, menopausal symptoms, urinary incontinence, pelvic prolapse, etc). Once those problems have been addressed, you are ready to book your annual well-woman exam.
If you are at our office for an annual well-woman exam, you will be receiving a brochure that explains in detail the services you can expect to receive during your visit. Our physicians follow the guidelines set forth by the American College of Obstetrics and Gynecology (ACOG).
Financial Agreements
If you have entered into a financial agreement with our office, we expect you to adhere to the terms of that plan. We offer these plans as a service to our patients and expect the courtesy of
prompt payment according the terms of that agreement.
Patient Billing Statements
Statements go out on a monthly basis. After charges are processed by your insurance company, you will receive a statement from our office indicating any patient balance due. Payment of the patient balance is due upon receipt. You will not be billed for charges due on an insurance claim until after we receive the Explanation of Benefits (EOB) from your insurance company. Your insurance plan determines what your patient responsibility is and that result is reflected in your statement from us. Please note that balances of more than 90 days past
due may be sent to collections.
Insurance rules and benefits are constantly changing and we do our best to verify your insurance coverage and benefits, however you are responsible for understanding your policy coverage. Please keep us up-to-date on any policy changes, new cards issued as well as any changes to your name, address and phone numbers. It is imperative that we are able to contact you regarding test results and to maintain continuity of your medical care.
We strive to keep the lines of communication open, so if you have any questions please contact our billing personnel at 941-745-5811.
Be sure to bring a photo ID and current insurance card to every visit. Payment is expected at the time of service.
