Patient Insurance
As we strive to provide quality care, we must be
mindful of insurance and payment issues. Health
care
organizations across the country are instituting
new
procedures to assist patients with the management
of their health insurance and out of pocket expenses.
We hope this brochure will assist you in understanding
your insurance responsibility and our relationship
with your insurance carrier.
Insurance
The University of Pennsylvania Health System
participates with many medical insurance plans.
It is important to understand that your insurance
policy is an agreement between you and your
insurance carrier. We will submit the claim on
your behalf, however that is not a guarantee of
payment of the claim. Should your claim be
rejected or only partially paid, your insurance
company should send you an explanation of
benefits. Ultimately, the fees are your responsibility.
If we do not participate with your insurance
plan, payment is expected at the time of service.
Coordination of Benefits
If both you and your spouse are employed and
have insurance coverage through your employers,
YOUR policy is your primary coverage. According
to insurance regulations, your spouse’s policy
provides secondary coverage.
Payment
Co-pays, deductibles, co-insurances and fees
for
non-covered services are expected at the time
of
your service. A $12.00 administrative fee will
be assessed if the co-pay is not paid at the
time
of service. For your convenience we accept
cash,
personal checks, Visa, MasterCard, American
Express and debit cards.
Health Maintenance Organization (HMO) Plans
- HMO insurance plans
may require a referral
from a primary care physician prior to you
obtaining services for specialty care. As a
patient, you are responsible for securing
referrals from your primary physician prior
to
making an appointment to see a specialist.
- If
you arrive for an appointment with no
referral you may be asked to:
- Contact the
primary care physician to obtain the referral
- Reschedule
your appointment
- Pay the estimated cost
of the service prior
to seeing the physician
- HMO insurance plans
also require that testing
such as laboratory work, X-rays, and physical/occupational
therapy be completed at specific
sites. As the patient, it is your responsibility
to know which site you must use for tests
and
services. You may obtain this information
through your primary care physician’s
office,
or your health insurance company’s
member
services department.
Other Insurance Plans & Agreements
- Non-Participating Referral
(NPR)
- Out of Network (OON)
- Point of Service Out of Network
- Point of Service Plans (POS)
- Preferred Provider Organization (PPO)
Point of Service and Preferred
Provider plans
usually offer a network of physicians and hospitals
that the member must select from when receiving
health care. Members receive maximum benefits
if they choose in-network providers. Members
may also choose to “self-refer” to an Out of
Network provider but a higher co-payment may
be applied and the plan may require higher
deductibles and/or co-insurance amounts.
If you
have chosen to use these options, please be
aware that your financial responsibility for
co-pays
and/or co-insurance may be significantly higher.
If we do not participate with your insurance
carrier,
we will schedule an initial physician appointment
for you for the limited purpose of providing
an
evaluation only. That visit will be considered
a
consultation only and is a “one-time” appointment
with the physician.
We will require that you speak
to a financial
counselor prior to scheduling additional services.
Our financial counselor will provide you with
an
estimate of the treatment plan cost. Should you
elect to have the recommended services, diagnostic
studies or other testing at one of our facilities,
a
deposit equal to 50% of the estimated total must
be paid prior to the service.
You may wish to
have such treatment or tests performed by another
provider who is a participating
provider in your insurance carrier’s network. If you
choose to do so, we will work with you to forward
copies of your medical records to the other
provider.
If your insurance plan states that it will only make
payment to you (the patient), you will be
required to
pay in full for all services rendered.
The
University of Pennsylvania Health System provides
financial counseling services to
patients regarding their ability to pay for services.
If you
are uninsured, have concerns about your
account or
have other questions concerning your insurance
coverage, please contact the financial
counseling department at 215-349-5300 or 1-866-615-8535.
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