SECONDARY INSURANCE. Having more than one insurer DOES NOT necessarily mean that your services are covered 100%. Secondary insurers have specific guidelines, stated in your contract with them, for what they will consider for payment in coordination with your primary insurance payment. We bill your primary and secondary insurance carrier as a courtesy. You are responsible for any balances after your insurance(s) has cleared. If the subsequent insurance carrier doesn’t pay after 45 days, we may turn the balance due to your responsibility. Subsequent insurance billing may be subject to a billing fee of $5.00 per claim.
SECONDARY INSURANCE. As a courtesy, we will bill your secondary insurance as long as you provide us with the correct and current information. You are ultimately responsible for any deductibles, co- pays, co-insurances, or non-covered services your contract requires. AGREEMENT: I request payment of authorized benefits to be made on my behalf to Mount Nittany Physician Group Orthopedics for services rendered to me. I understand that by my signature below, I am requesting payment be made and authorizing release of medical information as necessary to determine payment. My signature below authorized release of information to secondary insurers as well as primary in determining payment of a claim. I understand I am responsible for deductibles, co- pays, co-insurances, and non-covered services. I understand that ultimately I am responsible for all health services rendered to me. I understand and agree to the conditions of this policy.
SECONDARY INSURANCE. The Organization provides supplemental medical insurance for each Minor Participant at no additional cost. This secondary insurance may pay for expenses related to injuries or emergency illnesses incurred by the Participant, while at camp or traveling to/from camp, that are in excess of your personal health insurance. Policy exclusions and coverage limits apply. Expenses must be submitted to the Undersigned Person’s primary health insurance carrier first, then filed with the Organization’s supplemental insurance provider (a $25 deductible applies). Claim forms and contact information will be provided as needed.
SECONDARY INSURANCE. Do you have a second insurance that covers health care? ❒ Yes ❒ No Are your services to be paid by Worker’s Comp or Auto Accident Insurance? ❒ Yes ❒ No Are you using an EAP Employee Assistance Program to pay for services: ❒ Yes ❒ No If YES to any of the above, request and complete additional insurance information form.
SECONDARY INSURANCE. US Lacrosse provides supplemental medical insurance for each Participant at no additional cost. Therefore the participant must produce a valid US Lacrosse number. CONSENT TO MEDICAL CARE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
SECONDARY INSURANCE. Patients who are covered by more than one medical insurance carrier should notify the Practice at the time of registration. It is your responsibility to know the limitations of your supplemental/secondary policy. If you have two insurance policies, the co-payment of the primary insurance is collected at the time of service.
SECONDARY INSURANCE. The Texas Department of Insurance requires the patient to provide secondary insurance coverage to the provider if applicable. Patient agrees to provide such information as outlined below. Patient agrees to notify provider in the future immediately of any additions changes or deletions in primary or secondary insurance coverage. Initial/complete as applicable. My child has NO secondary insurance coverage My child has secondary insurance coverage as described on the attached demographics form.
SECONDARY INSURANCE. Patient’s
SECONDARY INSURANCE. We are unable to directly bill secondary insurers, with the exception of patients covered by Medicare and Medicaid. Billing any other secondary insurance must be done by the patient. If you have secondary insurance for which we would otherwise be considered “in-network” or “contracted” providers, please note that any and all services provided by us must be considered “non-covered” services under such contracts. The balance due on your account, after receipt of payments from primary insurers, must be paid in full by you. We will provide you with the documentation reasonably necessary for you to file your secondary insurance claim. If multiple copies are required for any reason, we will charge you reasonable administrative and copying fees. PREFERRED PROVIDER (PPO) / MANAGED CARE (MCO) PLANS There are numerous insurance networks in the Chicago-land area. Our physicians are not a part of all of these networks, and, therefore, we have not agreed to accept a reduced fee from all insurance companies. Many insurance companies pay a different percentage of charges based on whether or not the physician is a part of their network. It is the responsibility of the patient to know and understand the benefits of his/her particular insurance plan.
