Insurance and Payment. For In Network Provider: -We Currently Accept Aetna, Cigna, & United Health Care. Copayments are due at the time of service. Payment is due no later then the end of 31 days from the statement date. For Out of Network Providers: -We Accept Out of Network Providers (Except Medicaid). Payment for out of network is due at time of service. At the end of the session, you will be provided with a superbill containing the CPT diagnostic codes for you to submit yourself, to your insurance for reimbursement. Contact the membership number on the back of your insurance card. An insurance representative will direct you to the area on the insurance website where a reimbursement form can be printed out. You will complete that form, in addition to providing the CPT codes from the superbill. The form will then be submitted to your insurance company by either mail or fax to receive reimbursement.
Insurance and Payment. (a) Liability Insurance LVRE shall procure and maintain for the duration of this Agreement railroad liability insurance, with combined single limits for bodily injury and property damage of not less than $4,000,000 per occurrence, with respective named insureds on a primary basis.
Insurance and Payment. Payment can be with check, or cash. You will be expected to pay for each session at the time it is held, unless we agree otherwise. If there are problems pertaining to your situation, you may be required to pay in advance. Please have your checks made out in advance so as to save our time together for therapy and not payment. As a courtesy, I will be glad to file a claim with your insurance through my billing agency. In that case, you would only pay your deductible, co- payment, and amounts not covered by insurance at time of service. As the insured, you are ultimately responsible for determining what services are covered and to what degree. The situation may vary if I am a participating practitioner with your insurance company. I am currently a participating practitioner with Premera Blue Cross of Alaska, and FEP. Unfortunately, I am unable to accept Tricare, Medicaid and Medicare, as I am not a community provider, and there is not an MD on staff full time. Unless I am participating with your insurance company, I usually will not complete treatment reviews by companies who manage your benefits unless otherwise arranged between you and me. This is for clinical reasons that I will be glad to discuss with you. As this may affect your level of benefits, please understand how your insurance works with regard to mental health benefits when initiating services. I suggest that you call to verify your mental health coverage and any requirements your insurance company imposes to insure coverage. If your account has not been paid for 30 days or more and arrangements for payment have not been agreed upon, late payment fees of 7.5% per month will be charged, and I have the option of using legal means to secure payment. This may involve hiring a collection agency (in which case a 35% delinquency fee will be added to your balance) or going through small claims court (in which case, legal costs will be included in the claim, in addition to the time involved and interest). These situations are very rare, and require disclosure of otherwise confidential information (usually just name, the nature of services provided, and amount due). Please do not let this happen; I would much rather communicate and find some solution to overdue accounts. My signature below indicates that I have read this agreement, understand it, and agree to all of its terms, and I have received the HIPAA notice form titled “Notice of Policies and Practices to Protect the Privacy of Your Health Informati...
Insurance and Payment. In most cases, full payment for services rendered is expected at the time of service. In limited cases, however, I xxxx insurance companies on clients’ behalf. In these situations, I am willing to accept only a co-payment at the time of service. When this is the case, you are consenting to have the insurance company reimburse me directly for the balance of the full fee. However, please be advised that the ultimate responsibility for payment of services rendered is still the client’s. If an insurance company denies a claim for whatever reason, the client will be responsible for the payment in full. It is the client’s responsibility to be aware of the extent and limitations of coverage. If you have questions about your coverage, please contact your insurance company directly. If you choose to use insurance coverage to pay for services, you should be aware that your contract with your health insurance company requires that I provide it with information relevant to the services that I provide to you. If you have an Oregon insurance policy with the state law requirement that by accepting policy benefits, you are deemed to have consented to examination of your Clinical Record for purposes of utilization review, quality assurance and peer review by the insurance company, then I may provide clinical information to your insurer for such purposes. Sometimes I am required to provide additional clinical information such as treatment plans or summaries, or copies of your entire Clinical Record. In such situations, I will make every effort to release only the minimum information about you that is necessary for the purpose requested. This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, I have no control over what they do with it once it is in their hands. I will provide you with a copy of any report I submit, if you request it. By signing this Agreement, you agree that I can provide requested information to your carrier.
Insurance and Payment
