Pre-Authorization
Many insurance plans require prior authorization for hospital admissions and certain outpatient procedures or tests. In some instances, your physician may be aware of these requirements and will proceed with obtaining the proper authorization; however, it is impossible to know these requirements for all insurances and procedures. It is important that you check with your insurance carrier to verify if your procedure or test requires authorization and let your physician know. Claims denied for lack of pre-authorization may be billed to the patient.
Medicare
We are pleased to be a participating provider in the Medicare program and will file claims for Medicare beneficiaries. Patients are responsible for paying their annual deductible, if it has not yet been met. Co-insurance or non-covered services are the responsibility of the patient. If there is a supplemental coverage available, our office will file a claim to the second carrier as a courtesy; however, follow-up with the supplemental carrier, as well as amounts not paid, are the responsibility of the patient. Many supplemental and secondary insurances have a separate deductible that must be paid.
Medicare does not always cover a service. Certain types of routine care and diagnostic tests, braces, and orthotics, as stated in the Medicare benefits, may not be covered; Medicare patients should expect to be responsible for these services. Please note: this does not mean these services are not an important part of the health care being provided to you. Our office participates with most Medicare advantage plans or Medicare replacement plans. Please contact our office to verify if your Medicare Advantage plan is accepted.
Workmans Comp
Our office provides workers’-compensation-related services within several departments. When scheduling your appointment, please notify the receptionist that your visit is related to a work injury. In order to file your workers’ compensation claim, we are required to obtain the following information:
- Employer name, address, phone number and an employer contact
- Date of injury
- Claim identification number and/or employer authorization
- Name of workers’ compensation insurance company
- Claim address and phone number
- Insurance contact
This information may be obtained at the time of your visit or by phone. Attempts will be made through your employer to verify authorization for your visit. Patients seen for work-related injuries who are unable to provide the required information, or for whom the employer has not provided us with authorization, may be asked to make payment for their services.
Other Insurance
You may carry a commercial group plan that does not fall into one of the aforementioned categories. In most cases, as a service and courtesy to you, Modern Foot & Ankle will file your initial claim on your behalf.
You may be asked upon arrival to make a payment toward your anticipated out-of-pocket amounts such as deductibles or co-insurance. Any amounts unpaid by you and your insurance after the claim has been processed will be billed to you. You are encouraged to contact your insurance carrier prior to your visit to confirm your benefits.
Uninsured Patients
Our office welcomes patients without insurance coverage. To help offset the cost, we offer a Prompt-Pay Discount. Uninsured patients will be asked to pay their balance in full at each visit. Checks are not accepted for self-pay patients.