Financial Policy and Insurance FAQs
Insurance
- Will you file the insurance paperwork for me?
- Do I need to provide proof of insurance?
- What is the difference between an HMO and a PPO?
- What is an Explanation of Benefits (EOB)?
Financial Policies / Payments
- What is your financial policy?
- How and when do I pay for my visit with Dr. Gallina?
- What is a global fee?
Insurance Facts
Insurance is a contract between the patient and the insurance company.
Will you file the insurance paperwork for me?
As a courtesy, this office will file your insurance claim for you, provided you assign the benefits to the doctor and agree to have your insurance company pay the doctor directly.
Do I need to provide proof of insurance?
Be prepared to present your insurance card and proof of identity, such as a driver’s license at each visit. You will be responsible for providing a change of address, telephone number, and/or insurance information any time a change occurs.
What is the difference between an HMO and a PPO?
- Referrals and self-referrals
Preferred Provider Organizations (PPO):
- allow the patient to refer himself or herself to a specialist provider as long as that provider is listed on their participating panel;
- typically require a co-payment for the office visit, but may apply a deductible and co-insurance for other services provided by the doctor;
- allow patients to see physicians outside of their network, but they require you to pay a higher portion of your medical bills, including a deductible.
Health Maintenance Organizations (HMO) require the patient to have a referral from their primary care physician prior to being seen by a specialist. To obtain a referral, your primary care physician must communicate to the insurance company the need for you to see a specialist. You will then be issued a referral number for a specific time period, and a specific number of office visits.
HMO’s rarely cover office benefits or services provided by specialists without a referral. If you are unable to obtain a referral from your primary care physician, you will be asked to reschedule your appointment to ensure coverage by your insurance carrier.
Please note that some plans require you to pay a portion of other services. Several of the types of insurance plans, including point of service (POS) and exclusive provider organizations (EPO), may require a referral from a primary care physician. Please reference your insurance packet or human resources department, to determine whether or not you require a referral to see a specialist.
What is an Explanation of Benefits (EOB)?
After you receive care from Dr. Gallina, the office will file your insurance claim. Once the insurance carrier has audited the claim, the carrier will mail a copy of their payment to our office and to your home. The EOB is a line by line explanation of payments and contractual-write offs and will indicate the portion of the bill for which you are responsible.
What is your financial policy?
You will be asked to sign a financial policy statement at the time of your first visit.
The financial policy is intended to eliminate financial confusion and misunderstanding between our patients and the practice. Your complete understanding of the financial policy is an essential element in your care and treatment. Discuss any questions with the office manager.
How and when do I pay for my visit with Dr. Gallina?
- Payment is due at the time of service unless other arrangements have been made in advance by either yourself or your health care provider.
- Cash, check and most major credit cards are accepted.
- If payment is not received from the insurance company within a reasonable time period, you will be billed directly for payment. If a check is later received from your insurance company, you will receive a refund for any over payment.
- We have made prior arrangements with some insurance carriers and health plans to accept an assignment of benefits.
If you are covered by one of these plans, we will bill your plan, and you will only be required to pay the co-payment at the time of service.
When you call for an appointment, you must check with the office manager to see if your insurance carrier is one that we accept. If not, you must pay your deductible, and then your insurance company can be billed out of network. - All health plans are not the same and frequently do not cover the same services. If your health plan determines a service to be "not covered," you are responsible for the complete charge. Payment is due upon receipt of a statement from our office.
- We will bill your health insurer for unscheduled services provided in the hospital. Any balance remaining, after your health plan pays, is your responsibility. Payment is due upon receipt of a statement from our office.
- Your estimated portion of fees for scheduled surgical procedures is due prior to the surgery date. Any balance remaining, after your health plan pays, is your responsibility. Payment is due upon receipt of a statement from our office.
- If the patient is a minor, the accompanying adult will be responsible for all services rendered to the minor patient.
- You are responsible for promptly responding to your insurance company, providing any additional information they request regarding:
- your treatment
- pre-existing conditions
- accidents
- other insurance coverage.
What is a global fee?
When you are charged a "global" fee for surgery or office care of a fracture, laceration repair, excision, etc., that fee not only includes the service on the day it is performed, but includes routine follow-up care as well.
The global period usually ranges from 10-90 days depending on the procedure and the policy of your health plan.
X-rays and supplies, such as casting or dressing materials, splints, braces, etc. are not included in the "global fee" and a charge will be made for these items. Services related to complications are not included in the global fee.
