Private Insurance. If you have insurance or health care coverage, our billing service will bill your insurance company or health carrier for you. By entering into this contract, you authorize us to release health information to our billing service, and for our billing service to release health information to your insurance company or health carrier for the purpose of processing your claims. Our billing service may bill your insurance company or health carrier for the following services related to your care including, but not limited to: Initial visit; lab work; OB global fee including delivery; intrapartum care; supplies; IV therapy; newborn exams & newborn screens; postpartum home visits. (If global fee is not applicable, individual visits are billed.) If your insurance denies your claims, you are responsible for paying us the entire fee. If, upon verification of benefits, your insurance company is likely to pay, we may agree to only collect the deposit, your deductibles for you and your baby, and approximate coinsurance amounts (patient responsibility or “PR”) up front, rather than collecting the entire fee. If your insurance company pays, and we find that we have overcharged you, we will refund you accordingly. If the insurance assigns PR that exceeds what we have collected from you, we will bill you for the deficit. If you have insurance and you’ve paid the entire fee in advance, and if your insurance company pays us directly, we will send you a refund. Your refund cannot exceed the amount you prepaid less your non-refundable deposit. Your refund amount will be affected by your assigned PR amounts and any deductibles (for you and your baby) applied to our claims independently of reimbursement amounts we receive. If your insurance company reimburses you directly, you agree to cooperate with our billing service. Our billing service will determine how much of the reimbursement should be sent to us, and how much, if any, is yours to keep. In this situation, you agree to reimburse us immediately. Any unpaid balance remaining 30 days after the insurance reimbursement was sent is considered delinquent and is subject to a 1.5% monthly interest charge. Client agrees to pay a non-refundable deposit of $200.00 which covers adminstrative and insurance billing services. Vivante pays an average of $200-$250 to the billing service for each claim processed. The birth assistant fee of $400, is payable by check at 36 weeks, and is not billable to insurance. The birth assistant fee is paid directly to a third-party subcontractor. Client agrees to pay all third-party vendors and subcontractors for birth assistant fee.
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Private Insurance. Nurse-Midwifery services are covered by most insurance plans, though the amount of coverage varies from plan to plan. Your coverage may be limited by deductibles, reasonable and customary restrictions, co-payments and denials. If you have insurance or health care coverage, our billing service will bill your insurance company or health carrier for you. By entering into this contract, you authorize us to release health information to our billing service, and for our billing service to release health information to your insurance company or health carrier for the purpose of processing your claims. Our billing service may bill your insurance company or health carrier for the following services related to your care including, but not limited to: Initial visit; lab work; OB global fee including delivery; intrapartum care; supplies; IV therapy; newborn exams & newborn screens; postpartum home visits. (If global fee is not applicable, individual visits are billed.) If your insurance denies your claims, you are responsible for paying us the entire fee. If, upon verification of benefits, your insurance company is likely to pay, we may agree to only will collect a deposit ($500 at the deposit, your deductibles for you and your baby, and approximate coinsurance amounts (patient responsibility or “PR”first visit/$4,400 total) up front, rather than collecting before the entire feebirth. If Xxxxxx Billing Service will xxxx your insurance company pays, for the maternity care services using all applicable codes that represent the care we provide to you at usual and we find customary rates for those codes. The amount of the deposit has no bearing on the fees that we have overcharged you, we xxxx to the insurance company. The deposit will refund you accordinglybe applied to the deductible and co-insurance amounts applied by your insurance company to our claims. If the insurance assigns PR that company pays us directly, you may be eligible for a partial refund of the deposit. If the insurance company determines your patient responsibility (deductibles, co-insurances) amount exceeds what we have collected from you, we will bill xxxx you for the deficit. If you have insurance and you’ve paid the entire fee in advance, and if your insurance company pays us the claim to you directly, we will send you a refund. Your refund canwhich is not exceed the amount you prepaid less your non-refundable deposit. Your refund amount will be affected by your assigned PR amounts and any deductibles (for you and your baby) applied to our claims independently of reimbursement amounts we receive. If your insurance company reimburses you directlyuncommon, you agree to cooperate with our billing service. Our For any insurance checks you receive, an explanation of benefits reflecting that exact amount must be sent to the midwife ASAP. The billing service will determine how much of the reimbursement should be sent to us, claim payment is your refund and how much, if any, should be the midwife’s. It is yours not legal for you to keepprofit on your health care; therefore, any amount reimbursed by insurance that exceeds the deposit must be forwarded to us, along with applicable amounts to cover your deductible and co-insurance. In By entering into this situationcontract, you agree to reimburse us immediately. Any unpaid balance remaining 30 days after the insurance reimbursement was sent is considered delinquent and is subject to a 1.5% monthly interest charge. Client agrees to pay a non-refundable deposit of $200.00 which covers adminstrative and insurance billing services. Vivante pays an average of $200-$250 to authorize the billing service to release health care information to your insurance company for each the purpose of processing claims and agree to communicate and cooperate with Xxxxxx Billing’s representatives as needed for claim processedprocessing. The birth assistant fee All of $400, is payable by check at 36 weeks, the following needs to be sent to the midwife to facilitate proper billing and is not billable to insurance. The birth assistant fee is paid directly to a third-party subcontractor. Client agrees to pay all third-party vendors and subcontractors for birth assistant fee.refund calculations: ● All explanation of benefits letters (EOB’s) ● Letters from insurance company discussing the status of claims or billing
Appears in 1 contract
Samples: Financial Agreement
Private Insurance. Nurse-Midwifery services are covered by most insurance plans, though the amount of coverage varies from plan to plan. Your coverage may be limited by deductibles, reasonable and customary restrictions, co-payments and denials. If you have insurance or health care coverage, our billing service will bill your insurance company or health carrier for you. By entering into this contract, you authorize us to release health information to our billing service, and for our billing service to release health information to your insurance company or health carrier for the purpose of processing your claims. Our billing service may bill your insurance company or health carrier for the following services related to your care including, but not limited to: Initial visit; lab work; OB global fee including delivery; intrapartum care; supplies; IV therapy; newborn exams & newborn screens; postpartum home visits. (If global fee is not applicable, individual visits are billed.) If your insurance denies your claims, you are responsible for paying us the entire fee. If, upon verification of benefits, your insurance company is likely to pay, we may agree to only will collect a deposit ($500 at the deposit, your deductibles for you and your baby, and approximate coinsurance amounts (patient responsibility or “PR”first visit/$4,400 total) up front, rather than collecting before the entire feebirth. If Xxxxxx Billing Service will bill your insurance company pays, for the maternity care services using all applicable codes that represent the care we provide to you at usual and we find customary rates for those codes. The amount of the deposit has no bearing on the fees that we have overcharged you, we bill to the insurance company. The deposit will refund you accordinglybe applied to the deductible and co-insurance amounts applied by your insurance company to our claims. If the insurance assigns PR that company pays us directly, you may be eligible for a partial refund of the deposit. If the insurance company determines your patient responsibility (deductibles, co-insurances) amount exceeds what we have collected from you, we will bill you for the deficit. If you have insurance and you’ve paid the entire fee in advance, and if your insurance company pays us the claim to you directly, we will send you a refund. Your refund canwhich is not exceed the amount you prepaid less your non-refundable deposit. Your refund amount will be affected by your assigned PR amounts and any deductibles (for you and your baby) applied to our claims independently of reimbursement amounts we receive. If your insurance company reimburses you directlyuncommon, you agree to cooperate with our billing service. Our For any insurance checks you receive, an explanation of benefits reflecting that exact amount must be sent to the midwife ASAP. The billing service will determine how much of the reimbursement should be sent to us, claim payment is your refund and how much, if any, should be the midwife’s. It is yours not legal for you to keepprofit on your health care; therefore, any amount reimbursed by insurance that exceeds the deposit must be forwarded to us, along with applicable amounts to cover your deductible and co-insurance. In By entering into this situationcontract, you agree to reimburse us immediately. Any unpaid balance remaining 30 days after the insurance reimbursement was sent is considered delinquent and is subject to a 1.5% monthly interest charge. Client agrees to pay a non-refundable deposit of $200.00 which covers adminstrative and insurance billing services. Vivante pays an average of $200-$250 to authorize the billing service to release health care information to your insurance company for each the purpose of processing claims and agree to communicate and cooperate with Xxxxxx Billing’s representatives as needed for claim processedprocessing. The birth assistant fee All of $400, is payable by check at 36 weeks, the following needs to be sent to the midwife to facilitate proper billing and is not billable to insurance. The birth assistant fee is paid directly to a third-party subcontractor. Client agrees to pay all third-party vendors and subcontractors for birth assistant fee.refund calculations: ● All explanation of benefits letters (EOB’s) ● Letters from insurance company discussing the status of claims or billing
Appears in 1 contract
Samples: Financial Agreement
Private Insurance. If you have insurance or health care coveragewant us to xxxx your insurance, you must first register with our billing service company. Our office staff (billing department) can show you how to register with our billing company. There is a small fee (paid directly to the billing company) to register with them in order to verify your benefits. Once we have received your Verification of Benefits (VOB) from the billing company, we will bill know how much coverage to expect from your insurance company or health carrier for youinsurance. It is important to understand that in most cases, we are considered “out-of-network.” Until we receive your Verification of Benefits, your monthly payments (after the non-refundable deposit), will be based on our $4300 global fee (minus any applied discounts). By entering into this contractregistering with our billing company, you authorize us to release health information to our billing service, and for our billing service to release health care information to your insurance company or health carrier for the purpose of processing your claims. Our billing service may bill After we receive your verification of benefits, if you agree for us to file a claim on your behalf, you authorize us to xxxx your insurance company or health carrier for the following services related to your care including, but not limited to: Initial visit; lab work; , OB global fee including delivery; , intrapartum care; , birth assistance, supplies; IV , O2 therapy; , newborn exams & newborn screens; screenings and postpartum home visitscare. When we xxxx clients directly, we standardize all routine services into an early pay package fee (If a.k.a. global fee) which includes most of the client’s care. However, when we xxxx insurance and health carriers, we itemize services in accordance with each insurer’s claims payment structure. Due to claims processing and tracking, it is more costly to xxxx insurance than it is to collect directly from clients. We have the right to xxxx for any additional services we provide that are not covered under our global fee of $4,300.00. Once we agree to xxxx insurance on behalf of a client, the client is not applicable, individual visits are billed.) responsible for paying the practice enough to ensure that our minimum reimbursement will be $4300.00 regardless of insurance reimbursement. If you choose to have us xxxx your insurance and your insurance company denies your claims, you are will be responsible for paying us the entire fee. If, upon verification of benefits, your insurance company is likely to pay, we may agree to only collect the deposit, your deductibles for you and your baby, and approximate coinsurance amounts (patient responsibility or “PR”) up front, rather than collecting the entire fee. If your insurance company pays, and we find that we have overcharged you, we will refund you accordingly. If the insurance assigns PR that exceeds what we have collected from you, we will bill you for the deficit. If you have insurance and you’ve paid the entire fee in advance, and if your insurance company pays us directly, we will send you a refund. Your refund cannot exceed the amount you prepaid less your non-refundable deposit. Your refund amount will be affected by your assigned PR amounts and any deductibles (for you and your baby) applied to our claims independently of reimbursement amounts we receive. If your insurance company reimburses you directly, you agree to cooperate with our billing service. Our billing service will determine how much of the reimbursement should be sent to us, and how much, if any, is yours to keep. In this situation, you agree to reimburse us immediately. Any unpaid balance remaining 30 days after the insurance reimbursement was sent is considered delinquent and is subject to a 1.5% monthly interest charge. Client agrees to pay a non-refundable deposit of $200.00 which covers adminstrative and insurance billing services. Vivante pays an average of $200-$250 to the billing service for each claim processed. The birth assistant cash package fee of $400, is payable by check at 36 weeks, and is not billable to insurance. The birth assistant fee is paid directly to a third-party subcontractor. Client agrees to pay all third-party vendors and subcontractors for birth assistant fee4,300.00 plus any additional fees that are outside of routine care.
Appears in 1 contract
Samples: www.ccbirthcenter.com
Private Insurance. If you have insurance or health care coverage, our billing service will bill your insurance company or health carrier for you. By entering into this contract, you authorize us to release health information to our billing service, and for our billing service to release health information to your insurance company or health carrier for the purpose of processing your claims. Our billing service may bill your insurance company or health carrier for the following services related to your care including, but not limited to: Initial visit; lab work; OB global fee including prenatal visits; delivery; intrapartum carelabor management; birth assistance; supplies; IV therapy; newborn exams & newborn screensscreening; postpartum home visits. (If the global fee is not applicable, individual visits are billed.) When we bill clients directly, we standardize all services into a $6200 package fee. However, when we bill insurance and health carriers, we itemize services in accordance with the insurer’s claims payment structure, which may result in billing the payor in excess of the $6200 standard fee. Due to repeated claims processing and tracking expenses, it is more costly to bill insurance than it is to collect directly from clients. We have the right to accept reimbursement from insurance that exceeds the package fee of $6200. If your insurance denies your claims, you are responsible for paying us the entire package fee. IfBecause maternity care is billed after the birth of your child and may take several months for claims to be finalized, upon verification our practice requires $3100 (50% of benefitsthe total package price) to be paid by 36 weeks gestation, your insurance company is likely to pay, we may agree to only collect the deposit, your as calculated by us. This covers a portion of any deductibles for you and your baby, and approximate coinsurance amounts (patient responsibility (or “PR”) up front, rather than collecting the entire feenot covered by your insurance company or health carrier. If your insurance company pays, and we find that we have overcharged you, we will refund you accordingly. If the insurance assigns PR that exceeds what we have collected from you, we will bill you for the deficit. If you have insurance and you’ve paid the entire fee in advance, and if your insurance company pays us directly, we will send you a refund. Your refund cannot exceed the amount you prepaid less your non-refundable deposit. Your refund amount will be affected by your assigned PR amounts and any deductibles (for you and your baby) applied to our claims independently of reimbursement amounts we receive. As a practice, no matter what your insurance company assigns as far as deductibles, co-pays and coinsurance, we will never bill you in excess of our standard “out- of-pocket” cash fee of $6200 (or $9200 with Birth Center delivery). If, upon verification of benefits, your insurance company is likely to pay, we may agree to collect only the deposit, your deductibles for you and your baby, and approximate coinsurance amounts (patient responsibility or “PR”) up front. If, upon verification of benefits, your deductible is equal to or higher than our fee, we will not bill insurance. Full payment for services is expected by your 36th week of pregnancy. If you desire to have claims of care submitted towards your insurance deductible, $100 fee must be paid by your 36th week of pregnancy for claim submission billing services. If your insurance company reimburses you directly, you agree to cooperate with our billing service. Our billing service will determine how much of the reimbursement should be sent to us, and how much, if any, is yours to keep. In this situation, you agree to reimburse us immediately. Any unpaid balance remaining 30 days after the insurance reimbursement was sent is considered delinquent and is subject to a 1.5% monthly interest charge. Client agrees to The Bend Birth Center, Xxxxxxx Xxxxxx LDM and Xxxxx Xxxxxxx CPM LDM, will owe the billing service for the processing of your claims. The Bend Birth Center, Xxxxxxx Xxxxxx LDM and Xxxxx Xxxxxxx CPM LDM, pay a non-refundable deposit of $200.00 which covers adminstrative and insurance billing services. Vivante pays an average of $200-$250 350 to the billing service for each claim processed. The birth assistant fee of $400, So timely payment is payable by check at 36 weeks, and is not billable to insurance. The birth assistant fee is paid directly to a third-party subcontractor. Client agrees to pay all third-party vendors and subcontractors for birth assistant fee.appreciated! initials
Appears in 1 contract
Samples: Financial Responsibility Agreement
