Insurance Billing and Payment Questions
Independent Physician Medical Center is a preferred provider with the majority of insurance carriers available in our area. To service our patients better we continue to maintain and add new carriers regularly. If you have questions regarding your benefits, our staff in the billing department will work with you to try and answer those questions to the best of their ability. If there are any questions we cannot answer, we will do our best direct you to someone who can.
While it is primarily the responsibility of patients to verify with their carrier (Insurance Company) specific coverage for services rendered, at IPMC we do everything to help answer those questions for you prior to your appointment. If insurance coverage is not available please contact our billing department for an alternative method of payment. We will work out a financial plan that fits your budget.
Obtaining referrals or authorizations as required by your carrier (insurance company) is important to ensure accurate and timely processing of your claims. We will be sure to review and follow all guidelines for your carrier prior to your appointment, by making you aware of what is needed. Payments for co-pays are expected at the time of service and we try to accurately make you aware of these costs beforehand and will work with you if a payment plan is needed.
If you are unsure as to whether your procedure requires a precertification (preauthorization) or notification from your carrier (insurance company), the easiest thing to do is to call the number on the back of your insurance card and ask. Please keep in mind that for some insurances you need to call third party benefit administrator to obtain authorization or to get correct information about the necessity of precertification. Your referring physician’s office should get the precertification prior to you making the appointment.
Some questions you may have prior to your visit:
What is a preauthorization?
A requirement by an insurance carrier that medical services be approved by the insurer or their contracted third party before the service is allowed to be rendered. A pre-authorization is not a referral.
What is a referral?
A referral is usually an electronic document, though some still come in paper form, which comes from your primary care physician. It literally means that they are referring (or sending) you to a specific place to do a specific procedure. Only certain types of insurances (such as HMOs) require these. However, if your insurance does require it and none is made out, your procedure will not be covered.
What is covered?
It is imperative that you understand that we tell you all the information that your carrier (insurance company) tells us prior to the appointment. However, the final decision on the part of the carrier as to what is covered is made after we submit our claim.
What is a prescription?
An official piece of paper stating your name, the referring physician’s name (signature), the name of the procedure requested and the date. Everyone needs a prescription regardless of whether or not they have insurance and what kind of insurance it is. No tests will be performed without a prescription.
What is a co-pay?
A co-pay is a fixed amount that an insurance subscriber has to pay every time a certain procedure is performed. Your card may have the co-pay required for your primary physician and a specialist, but these are probably different amounts from the radiological procedure co-pays. Your insurance company will be able to tell you specifically which procedures require co-pays and in what amounts.
What is coinsurance?
Unlike a co-pay, a coinsurance is not a fixed amount, but a fixed percentage of the procedure cost. This is the percentage that the patient is required to pay for each procedure after the deductible has been paid. This usually comes in the form of 80/20 or 90/10 where the bigger percentage is paid by the insurance company while the smaller is the responsibility of the patient.
What is a deductible?
Simply put, the deductible is the amount that the patient has to pay out of pocket, starting at the beginning of each year. Once that amount has been paid then the insurance policy kicks in. This amount varies from $0 to as much as $10,000 and until that amount is paid out nothing will be covered by the insurance. In these cases we usually charge a percentage of the deductable at the time of the appointment and send a bill for the rest.
For which exams do I need a preauthorization (precertification) or notification?
Most insurance carriers require a preauthorization for MRI, MRA, CT, CTA, nuclear stress test, and PET scans.
We do accept Worker’s Compensation and some Motor Vehicle injuries.
Accepted forms of payment are major credit cards, check, money order, or cash.
Please call us if we can be of further assistance and thank you for choosing IPMC for your imaging needs.
Billing Department: 215-464-3300, ext. 1261.