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Financial Policy

Welcome to Rockwell Physicians. We are here to serve and care for you and to provide you with the highest level of professional medical care with the highest degree of patient satisfaction. One important aspect of optimal patient care is to have an agreement as to financial responsibility to avoid any misunderstandings.

Rockwell Physicians’ policy requires that all patients sign the Authorization and Consent for Treatment Form prior to receiving medical services. The form confirms that patients understand services being provided are necessary and appropriate. The form also advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.

Payment Responsibility

Patients or their legal representative are ultimately responsible for all charges for services rendered. Payment is expected at time of service for all charges owed for the current visit as well as any prior balance. For those insurance plans with real time adjudication, payment will be collected at check out for charges incurred that day. For insurance plans that do not provide immediate patient responsible information, settlement of your balance can be accomplished via credit card-on-file (preferred) or you may pay a deposit on date of service.

For card-on-file, we will charge your card for the balance you owe as soon as your insurance company informs us of the patient responsibility. Under the deposit option, you may pay an estimate of the expected patient responsibility and we will settle the balance upon receipt of the Explanation of Benefits (EOB) from your insurance company by either sending a refund in case of overpayment or send a statement for the balance due. Both payment options benefit you by reducing administrative burden and settling your portion of the bill in a timely manner.

For Annual Wellness visits or Physical Exams for which you require additional services beyond the scope of the wellness exam or physical, an additional charge will be incurred and you will be asked to pay resulting additional copayments or patient responsibility amounts.

All services rendered to minor patients will be billed to the accompanying adult, custodial parent or legal guardian. In cases of large patient balances, payment plans are available. Ask to speak to the office manager to make payment arrangements.

Types of Payments

  1. Co-payments. Privia Medical Group is required by insurance carriers to collect co-payments at the time of services are rendered. The patient’s appointment may be rescheduled if he/she is not prepared to make this payment.
  2. Deductibles. Some insurance plans require patients to pay a predetermined amount before services will be covered.
  3. Co-insurance. Some insurance plans require that patients pay a predetermined percentage (e.g. 20%) of the allowed charge amount.
    • If amount can be determined at time of service, amount will be collected.
  4. Uninsured Patients (Self-Pay). Payment for all services rendered is due at the time of service. Patients paying the total of charges for that day’s visit will be given a prompt pay discount. If the total charge amount is not available at the time of checkout, the patient will be required to pay a deposit that will be applied to his/her charges. If the deposit exceeds actual charges then a refund will be issued.
    • New patients: total charge or a minimum $200 deposit.
    • Established patients: total charge or a minimum $150 deposit.
    • If having a procedure, patient will be required to pay the total charge amount of the anticipated charges or a minimum $200 payment to the provider’s office prior to the procedure being performed.
    • Balances must be paid in full before a next visit can be scheduled.
  5. Out-of-Network. We participate with most major insurance plans. You can contact your insurance company to confirm if your provider is in network prior to making your appointment. Patients being seen as Out of Network will be required to pay a payment for that days visit at the time services are rendered. We will courtesy bill your insurance company. If the total charge amount is not available at check out, the patient will be required to pay a deposit that will be applied to his/her charges as described in the Payment Responsibility section above.
    • New patients: the total charge amount or a minimum $200 deposit.
    • Established patients: total charge or minimum $150 deposit.
  6. Non-Covered. “Non-covered” means that a service will not be paid under a patient’s insurance contract. If a patient is unsure whether a service is covered by his/her plan, it is ultimately the patient’s responsibility to call his/her insurance carrier to determine what the schedule of benefits allows. If non-covered services are provided, the patient will be expected to pay for the services at the time of service. Appeal procedures are generally available and billing staff will assist patients in attempting to resolve adverse determinations. Under no circumstances will billing staff falsify or change a diagnosis or symptom in order to convince an insurer to pay for care that is not covered.
    • For Medicare, all non-covered services will be communicated to the patient prior to treatment and documentation of his/her acceptance of financial responsibility will be obtained prior to providing service. The Centers of Medicare and Medicaid Services (CMS) has mandated the form CMS-R-131 (03/08), Advance Beneficiary Notice (ABN) to be used for this notification.

Insurance

All patients must present their insurance card (if applicable) and proof of identification (e.g. Photo ID, Driver’s license) at every visit. Patients who do not provide current proof of insurance will be billed as a self-pay patient. If at a later time the patient presents his/her insurance card(s), services already rendered may or may not be retroactively billed depending on the insurance’s claim filing requirements.

The patient’s insurance is a contract between him/her (and/or employer) and the insurance carrier. Privia Medical Group is not a part of this contract. For this reason, we will not waive copays or deductibles.

Patients are responsible to:

  • Check with their insurance carrier to determine if prescribed testing is covered under their medical coverage policy. (If patient chooses to have non-covered testing, payment in full at time of service will be required.)
  • Contact the insurance carrier to determine the schedule of benefits and if a co-payment or deductible applies.
  • Arrive for appointments with proper documentation.
  • Appeal adverse determinations.

Insurance Verification. Verification of patient’s insurance eligibility will be done either electronically through the practice management system or manually, 2 business days prior to scheduled visits. If staff members are unable to confirm active insurance coverage for a patient, the patient will be contacted and advised of his/her insurance eligibility status. Patients who are unable to present an alternative form of active insurance coverage prior to the visit will be informed that they classify as self-pay and will be required to pay at the time services are rendered or may reschedule their appointment. For same day appointments, eligibility will be checked as the appointment is made.

Insurance Claims Processing. Privia Medical Group accepts assignment of benefits for many third-party carriers. In accordance with the insurance carrier contracts patients will be required to pay co-payments at the time services are rendered. Privia Medical Group will submit charges for services rendered to the insurance carrier. The patient or guarantor will be expected to pay the entire amount that is determined to be patient responsibility. These fees are for physician services only and there may be additional bills from laboratory, radiology, or other diagnostic related providers.

Non-contracted Insurance. If non-contracted “out of network” insurance (an insurance company with which our providers are not contracted) has not paid within thirty (30) days, the remaining balance, beyond the amount we collect at time of service, is the patient’s responsibility.

No Surprise Act

If you do not have insurance or are not using insurance to pay for your care, you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the NO SURPRISES ACT, health care providers must give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least one (1) business day before your medical service or item.
  • You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call 1-888-774-8428.

Outstanding Balances

Any outstanding balance that is due from the patient is payable in full upon receipt of statement. In the event a patient presents for an office visit and has an outstanding balance, a request for payment will be made. A minimum due at the time of service will include the estimated patient cost for the current visit and the lesser of the outstanding balance or $100.

Statements are generated on a twenty-eight (28) day cycle. Patients who fail to respond to statements will be placed into collection status. Patients with an outstanding balance for more than (90) days may be referred to an outside collection agency and will be charged the lesser of $20 or the actual collection fee in addition to the balance owed.

A patient with unpaid delinquent accounts or accounts which have been written off to bad debt may not receive additional scheduled services unless special arrangements have been made. The patient may be discharged from the practice, however, in all situations the urgency of treatment will be taken in consideration.

No-Shows. If a patient fails to show up for an appointment, Rockwell reserves the right to charge the patient $20.00 to cover our associated cost. Payment will be due before the next visit.