| The
primary rule in today's health care environment is
CALL
YOUR INSURANCE COMPANY/HEALTH PLAN and
ask questions.
Health
Maintenance Organizations or HMO's/Health Plans, in general, need
referrals to be brought to us by you, the patient. Only in very
rare instances are they allowing faxes or phone calls to replace
a referral in hand. In most cases you will need two referrals
at the time of your initial visit, one for the physician's visit
and one for x-rays. These must be on two separate referrals. One
referral should be in the doctor's name and the other made out
to Good Samaritan Hospital Radiology Department.
Under
most other insurances you will be required to pay the professional
fee at the time of service and collect reimbursement directly
from your insurance company. The professional fee ranges anywhere
from $57.00 to $290.00 depending on the complexity of your case
as well as the reading of x-rays. We are prepared to accept cash,
check and MasterCard, Visa or American Express.
If
you have Medicare and are now enrolled in a Managed Care Program,
you must now obtain prior authorization from your new Primary
Care Physician before your scheduled visit. Your Primary Care
Physician's telephone number will be located on your new card.
If
you have Medicare, are not enrolled in a Managed Care Program
but have a secondary insurance, you will not be required to pay
anything up-front initially. We will submit your insurance claims
to Medicare and your secondary insurance(s) for you.
If
you have only Medicare, are not in a Managed Care Program and
have no secondary insurance, you will be required to pay the standard
20% associated with Medicare which would be somewhere in $11.00
to $58.00.
For
anyone on Medicare in Maryland there is a toll-free hotline to
answer any and all questions you may have, regardless of whether
you are with a managed care program or not. Their number is
1-800-444-4606
and they are available Monday through Friday 8:30 AM to 4:30 PM.
If
this is a Workman's Compensation Case, please bring a copy of
all billing information with you. If you have no insurance you
will be asked to pay in full for your visit at the time of service.
Under
any cases where referrals are needed, and if not provided, you
will be either asked to pay in full at the time of your visit
or to reschedule.
All
the above information relates to clinical visits. If it is determined
that you need surgery, someone will be able to assist you with
getting authorizations, knowing what expenses to anticipate, and
when payments will be expected.
We
are sorry that this has become so complex and laborious, however,
these are rules imposed on you and us by the insurance industry.
We are here primarily to care for your orthopaedic needs.
Together
we will work to navigate through the complexities of insurance
requirements to the maximum benefit for both you the patient and
our office.
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