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Billing

We are very pleased to inform you that as a courtesy to our patients we will file claims with your insurance company for all health care services provided during your visit.

Before each visit, we encourage you to contact your insurance company’s Customer service Center to discuss what is covered, what is not covered, and what your co payment or coinsurance is for office visits, laboratory procedures, and mammograms. This will ensure you have an estimate of what your out-of-pocket costs will be for each visit and/or service provided. Please call us if you have any questions about what services may be provided during your visit.

At the time of your appointment, we will collect your co-payment or coinsurance due for services provided. We accept cash, checks, and credit cards for payments. Please let our receptionist know when you arrive for your appointment how you would prefer to pay for your services.

Please note that your attending physician may provide a service based on his/her professional judgment that is later deemed a “non-covered benefit” by your insurance. If you receive a “non-covered benefit” notice from your insurance company, please call them for more information.

Any account not paid as agreed upon by you and our Business Office will be sent to our collection agency. This action will discharge you from the practice. You will be responsible for collection fees and any associated attorney’s fees. Again, please call us whenever you have any questions or concerns about your account before further actions are necessary.  We will be very flexible to arrange a payment agreement to resolve your account balance, so please contact the office to avoid your account unnecessarily being sent to collections.

We try to promptly refund any overpayment to the appropriate payor (you or your insurance company). Please note that any overpayment on a specific procedure (surgery, etc.) will be applied toward any other outstanding charges on the account before a refund amount is determined. If you believe that an overpayment was made, please call and we will gladly review your account with you.

As of January 2013, we have contracted with ALN Medical Management to process all of our claims and send out patient statements.  If you have questions regarding dates of service post 2012, please contact them at: 866-740-7984.

Financial Policy

In order to reduce confusion and misunderstanding between our patients and our practice, we have adopted the following financial policy. We are dedicated to providing the best possible care and service to you. We regard your complete understanding of your financial responsibilities as an essential element of your care and treatment.

FULL PAYMENT IS DUE AT THE TIME OF SERVICE, unless other arrangements have been made in advance by either yourself or your health coverage carrier (medical insurance). For your convenience, we will accept VISA and MASTERCARD.

Your Medical Insurance

If you do not bring us sufficient information to bill your insurance (i.e., Name, address, phone numbers of the insurance company, medical group name if relevant, ID and group numbers, date of birth and name of primary insured), then full payment is due at the time of service.

IT IS THE POLICY OF OUR OFFICE TO COLLECT ANY COPAYMENT WHEN YOU ARRIVE FOR YOUR APPOINTMENT. We hold contracts with many insurers and health plans. We will bill those plans with which we have a contract, and will only require you to pay the authorized co-payment at the time of service. If your health plan determines a service to be “not covered”, you will be responsible for payment for the complete charge. Payment is due upon receipt of a statement from our office. If we determine prior to your visit that a service is “not covered”, full payment is due at the time of service.

If you have insurance coverage with a plan with which we do NOT have a contract, we will be happy to prepare and send a claim for you on an unassigned basis. This means that your insurance will most likely send payment directly to you. Due to this, payment is due upon receipt of a statement from our office.

Please Fill out the Financial Policy Form and bring it into our office or Fax it to: (925) 935-1070

Insurance

I am a provider on most PPO plans in this area and currently have limited availability on certain HMO plans for reasons stated in the following excerpt regarding insurance types. Keep in mind, however, that most if not all PPO plans will cover visits and treatment with “out-of-network” physicians should you not find my name on your insurance physician panel. “Out-of-network” visits are usually associated with different co-pays and deductibles.

Questions About Eligibility

Should you have any questions regarding your ability to be seen in our office, please call us and inquire. Insurance issues are often terribly confusing, and we are almost always able to provide answers to our patients’ questions. Additionally, we are happy to bill your insurance for you for care provided by our office.

Evaluation / Treatment When Not Eligible

If you would still like to see me and I am not on your insurance plan, cash, check, or credit cards are accepted. Affordable payment plans are available as needed.

Explanation of Insurance Types

Perhaps background on the distinction between insurance plans will help you if you are considering changing your current coverage benefits for you and your family.

There are currently two major types of health plans: HMO (Health Maintenance Organizations) and PPO (Preferred Provider Organizations) with its alphabetical cousins, POS (Point of Service) and EPO (Exclusive Provider Organization).

HMO (Health Maintenance Organizations)

This type of coverage places your primary care physician (PCP) as the “gatekeeper,” who must approve referral to specialists. This approval process requires that your PCP completes forms subject to the approval of the HMO. Your PCP is limited to referring to the panel of specialists commonly referred to as in-network specialists. In-network specialists agree to deeply discounted fees in return for these referrals. Your already overworked PCP is often inundated with referral paperwork.

The PCP is also graded by your health plan based on the number of specialty referrals that are made. As a result, additional pressure is placed on your PCP when they must refer a patient. PCPs with an inordinately high rate of referrals may be penalized or even dropped from an insurance plan.

Once at the specialist’s office, authorization hurdles must again be navigated. Your specialist is often handcuffed in treatment options based on decisions made by the HMO management.

The advantage to you, the patient of an HMO, is often lower premiums and lower co-pays, although if you go to a specialist who is out of network, the HMO is not obligated to pay for your care. You also have limited geographic coverage, except in emergency situations.

Due to these deeply discounted fees, specialists must often limit the appointment availability, effectively limiting your access to appropriate care.

PPO (Preferred Provider Organizations)

This type of coverage does not employ the PCP gatekeeper approach. Your PCP answers only to you and not an insurance company bureaucratic panel. While you will continue to rely on your PCP for when to see a specialist, your treatment is virtually unimpeded. You will still have affordable co-pays. The insurance premiums might be slightly higher, but consider the advantages noted below.

Self-referral to most specialists.
Quicker access to top specialists.
Reduction of paperwork and authorization hassles.
Minimal interference in the physician-patient relationship.
Reducing the paperwork reduces our administrative costs so that we can focus on providing you with better health care. This is really about a physician-patient relationship. My goal is to provide you with the very best in health care options. You deserve that.

I would encourage you to select your health care coverage very carefully. While your human resources department or insurance professional will be best able to discuss your plan specifics, my office staff would be happy to assist you in any way we can.

Please feel free to call Jessica or Jody in our office. They will be available to assist you in finding the best health care coverage for you.

Womens Health Partners of California (WHPCA)

Our office is a division of Women’s Health Partners of California, Inc. (“WHPCA”), which is a group of 12 Walnut Creek area Ob/Gyns who are committed to providing the highest level of care to our patients. Please note that if you plan on transferring to or if you are coming from another WHPCA physician we ask that you notify our office of your transfer. In addition, because we constitute a single organization, any balance due to another physician within WHPCA will need to be paid prior to being seen in our office.

If you have any questions about our billing practices, please contact our office manager, Jessica, at 925-935-5356.

Thank you for your understanding. We look forward to building long relationships with all of our patients as we continue to provide the best possible Ob/Gyn care in our community.

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