FINANCIAL POLICY: IthacaMed is committed to the success of your medical treatment and care.The practice provides equal access to all patients regardless of source of payment. For your convenience, we have answered a variety of commonly-asked financial policy questions below. Fees are standard and based on the complexity of your visit. Each visit is documented in your medical record and a diagnosis is made by the provider. Diagnoses are made based on medical information, not based on coverage by Insurance Companies. To request a diagnosis change solely for the purpose of securing reimbursement from an insurance carrier is inappropriate and is considered insurance fraud and codes will not be adjusted under any circumstances for the benefit of reimbursement by your insurance plan. Accepting your insurance does not place all financial responsibilities onto the practice, and you will be held accountable for any balances your plan does not pay.
PATIENT RESPONSIBILITY: Services will be provided by the providers, and and in turn you as the patient will be held liable for the portion of the cost of medical care for which you are responsible.
Required at the time of Check-In:
- Verify all Contact Information and report changes
- Present Current Copy of Insurance Card
- Present Current Picture ID (yearly)
- Make Payments on Outstanding Balances (if applicable)
- Make co-payment/payment on the date of service.
We will verify your coverage at each visit. If we are unable to do so, you will be considered self pay and will be responsible for your visit on that date of service.
SELF PAY: In order to address the needs of our self-pay patients (without insurance, or qualifying coverage on the date of service) we offer a 30% discount off standard fees. This discount acknowledges the lower cost involved in billing and collections when a claim does not need to be submitted to a third party payer. In order to qualify, payment needs to be made IN FULL prior to or on completion of your visit or procedure. Any remaining balance after the date of service is not eligible for a discount. This discount applies to all medical services provided, offered only at time of service. This policy does not apply to any miscellaneous charges or patients covered by a non-participating plan.
PAYMENTS FOR SERVICES: While filing insurance claims is a courtesy that we extend to our patients, all charges are your responsibility from the date services are rendered. Before your visit, contact your insurance company to verify that we are participants in your plan, and that the services you intend to receive are covered. In order for us to file a claim, you must present a current copy of your insurance card at each visit, and it is your responsibility to communicate any changes of personal information. Not all services are a covered benefit in all policies, so it is very important that you understand the provisions of your individual insurance policy. Insurance companies select certain services that they will not cover, therefore we can’t guarantee payment of all claims by your insurance company. Reduction or rejection of your claim does not relieve you of your financial responsibility.
REFERRALS & PRIOR AUTHORIZATIONS: It is your responsibility as the patient to familiarize yourself with your insurance plan. If your plan requires that you have prior authorization you will need to make sure that has been completed before any services are rendered. In the event that the rendered service is denied payment due to no authorization you may become responsible for the balance denied based on your insurance policy. Being referred by another physician does not guarantee that your insurance will cover the services. Please remember that you are 100 percent responsible for all charges incurred: your physician’s referral and our verification of your insurance benefits are not a guarantee of payment. You are required to obtain prior authorization if your plan requires. We highly recommend you contact your insurance carrier and check into your coverage before your visit.
ANNUAL EXAMS (PHYSICALS): Please inform the office if you have had an Annual exam with any other provider outside of our office. Depending on your insurance coverage, these services may not be covered. Some insurance companies are very strict in enforcing time limits between visits and may not cover your visit if you are even one day early.
INSURANCE: IthacaMed will assist patients in making every effort to collect payments from the guarantor’s insurance company through courtesy filing of insurance claims and other required documentation if requested. Since most carriers have time limits on filing correct information on the claims, it is imperative that we receive complete and correct insurance information. We ask that you bring your card with you to every office visit. Though assistance is provided by our office, it is the patient’s responsibility to make sure the insurance carrier pays the claims. Although we are contracted with most insurance carriers, our services may not be covered by your particular insurance plan.
MEDICARE & MEDICAID: IthacaMed is a provider for the Medicare program and we gladly accept patients with Medicaid. Your current card must be presented at each visit. Due to recent changes in the state Medicaid policies, patients may be switched between payers from month to month so we ask that you make sure to update the office of any changes. At this time we are non-participating with Fidelis, and cannot see you in the event that you are covered by this plan.
HOSPITAL/OUTSIDE CHARGES: IthacaMed will bill your insurance for any visit that Dr. Law provides to you while you are an inpatient at the Cayuga Medical Center. Charges for services that are submitted by the laboratory, pathology, hospital or other healthcare professionals that are not employed by IthacaMed will not be billed by our office. You will be billed separately by Cayuga Medical Center for any additional services that are completed.
PAYMENTS ACCEPTED: We accept payment by cash, check, VISA, Mastercard, American Express and Discover. You may call the office to set up a payment plan or register for auto pay on our website.
PARTICIPATING INSURANCE PLANS: 𓀀 Excellus Blue Cross Blue Shield 𓀀 Medicare 𓀀 Straight Medicaid 𓀀 RMSCO 𓀀 GHI HMO 𓀀 MVP Preferred/PPO 𓀀 MVP 𓀀 Aetna 𓀀 Aetna CPHL 𓀀 Cigna 𓀀 POMCO 𓀀 Total Care 𓀀 TriCare/Champus
NON-PARTICIPATING PLANS: If you are insured by a plan that we do not have an arrangement with or if IthacaMed is considered to be out of network, we will send the claim to your insurance company as a courtesy. This means the insurer will reimburse you per your contract. If you are unsure of your out-of-network coverage you should contact your insurance company directly. Payment is due at the time of service unless other financial arrangements are made in advance. If you cannot pay the full amount, please discuss payment options available to you. We will make every effort to work with you to help resolve your financial obligation to this facility in the event that you have experienced a financial hardship.
MOTOR VEHICLE ACCIDENT (MVA); NO FAULT: Please notify the staff if your appointment is due to a MVA. If so we require that you provide the office with completed paperwork, this can be found under resources. The insurance carrier information is required at the time of your visit and cannot be billed to your commercial carrier. Also, please notify our office if an attorney is representing you as you will need to sign a HIPAA release to discuss your case. Our office policy for auto accident injuries is as follows:
1) IthacaMed will submit all visits pertaining to the injury to the carrier you have provided regardless of who is at fault.
2) Billing will be submitted to the patient’s health insurance if there is no coverage available or it has been exhausted.
3) If you have not provided IthacaMed with the correct no fault information you will be made self pay for all visits pertaining to the injury due to the MVA.
IthacaMed reserves the right to seek reimbursement from any and all of your insurers regardless of whether you provide us with their contact information, unless you instruct us to bill you directly.
We want to help you understand how insurance companies define office visits and help you expect what your out-of-pocket expenses might be. Knowing ahead of time what type of exam a patient needs helps the office staff assign appropriate time and resources for their appointment. Please keep in mind that once you are in with the provider, your visit category may change. For instance, you may schedule a preventive visit but, during the visit things change and your provider ends up evaluating or treating a health issue. The specific charge could change from the original intention of the visit.
There are two main categories for visits. The first is called E&M (evaluation and management) and is when you need treatment for an active disease such as the flu, earache, bladder infection, diabetes or high blood pressure. The second type is a preventive visit, also called a physical or checkup. This type of visit screens for unidentified illnesses and can include counseling by the doctor to encourage a healthy lifestyle to prevent future disease.
Evaluation and Management Visits (E&M)
Whether you see a provider for a limited medical problem or for a complex range of problems, your visit requires evaluation and management of your issues. You will be asked you about your symptoms, changes since your last visit, and determine the next steps for your treatment.
Examples of E&M visits include:
- Illness visits or follow up to an illness visit
- Management of existing chronic diseases (like diabetes) and medicine refills
- Emergency or urgent care follow up
- Follow up after hospitalization
- Pre-operative clearance exam
Preventive visits, or a physical or check-up, screen for disease or sickness and promote healthy living. Often, when a patient calls and asks to get “established” with a doctor or wants a “physical”, the staff will schedule the patient for a preventive visit. Depending on a patient’s age and gender, a preventive visit may include:
- Screening tests
- Blood pressure
- Obesity evaluation
- Diabetes Type II screening
- Depression screening
- Alcohol misuse
- Pap test
- Sexually transmitted disease, if at high risk
- Immunization evaluation and updates
- Counseling for healthy lifestyle changes
Examples of Preventive visits include:
- Preventive visit (check up) with/without an annual gynecological exam
- Pre-employment, school, camp, or sports physicals (BILLED AS SELF PAY)
For both E&M and preventive care visits, certain services and tests may carry a separate charge and potentially may not be a covered expense, in which you will be billed for the amount in full.
What Kind of Visit Does My Insurance Cover?
We file claims as a courtesy to our patients. We can’t predict how your insurance will pay for your services because benefits vary greatly. We recommend contacting your insurance company before your visit. Health insurance is a contracted relationship between you and your health insurance company. Therefore, when there are delays in payment from your health plan, you may receive a statement from your office. Sometimes additional information is needed from you to process the claim. Please call your insurance company regarding the non-payment before calling our billing office. Also, some insurance companies have reduced benefits for mental health treatment, preventive care. If you need to be seen for depression, anxiety, or have other mental health needs, or your requesting that you have a physical, talk to your insurance company to see if these are covered expenses to avoid surprises later. If you have no insurance but will self-pay, you will receive a 30% discount if payment is made at the time of service. You can pay a bill online by logging into the online portal at Athenahealth
As always, we will be happy to assist you with questions regarding your bill. Our new service allows to keep your credit card on file to make payments at the time of your statement, so you won’t need to worry about calling in or mailing your payment! The office can take payments online, in the office by phone at 607-277-0969.
Please contact your insurance company with any questions regarding your coverage. It is your responsibility to verify coverage or prior authorizations before your appointment, lest you be held financially responsible. You should also verify that all required medical records are in place before your appointment or your appointment may be delayed. We have forms online to complete the process.
MISCELLANEOUS CHARGES NOT COVERED BY INSURANCE CARRIERS
BROKEN APPOINTMENTS: $40.00-Missed/canceled/rescheduled appointments without 24 hours notice causes unnecessary expense and increased overhead for the office. If you cannot make your appointment please notify the office 24 hours in advance. As a courtesy we do complete reminder calls two days in advance as well as send out an email/text reminder with the option to reschedule. The broken appointment fee will then be applied to your account. This must be paid prior to rescheduling. In the event that you have two or more broken appointments, IthacaMed has the right to discharge you from care.
SAME DAY REFILL REQUEST: $10.00-IthacaMed requires 48 hours notice on on prescription refill request. If you call into the office to request a same day refill you understand that a service fee may be applied to your account. We strongly encourage patients to ask for prescriptions at the time of your scheduled office visit.
PAYMENT DUE ON DATE OF SERVICE: $15.00- All services rendered must be paid for at the time of service. If payment is not made at the time of service a charge will be added to your bill. This applies to co-pays that are not paid at the time of service (unless carrier specifies co-pay n/a)
Forms require additional information and take considerable time for the staff to complete. We are happy to complete these forms for you for a small fee. There is a 5-7 business day turnaround and must be payable in advance as this is not payable by insurers. The office will ask you to complete a HIPAA Records release, along with payment prior to processing forms.
FAMILY MEDICAL LEAVE (FMLA)/ DISABILITY: $45.00- If your employer requires Family Medical Leave Act (FMLA) or Disability paperwork to be completed by a provider we require that you have an appointment to go over the diagnosis (reason for disability/leave) to best answer the questions, and the provider will complete the paperwork at that time. Your appointment will be billed to your insurance, however the processing fee, falls into patient responsibility.
PAPERWORK ONLY: $10.00 processing fee and $5.00 each additional page- Payable in advance as this fee is not payable by insurers. Life insurance, work, legal, school, sports, or camp, etc.
PHYSICAL FOR FORMS: $60.00*- If a physical is required to complete forms, take note that the appointment is an out- of- pocket expense as these types of appointments are not covered. Forms will be completed at the time of the appointment, at no additional cost. *Max. Two pages, standard fee applied for each additional page. Not payable by commercial insurers, payable prior to scheduling an appointment.
NYS DMV PERMANENT HANDICAP PARKING APPLICATION: We ask that you bring this form with you to your appointment to be completed at no cost. If the form is asked to be completed outside of a scheduled office visit, the paperwork fee as listed will apply.
RETURNED PAYMENTS (CHECK & CREDIT CARD): $20.00- Non Sufficient Funds (NSF) checks/credit card transactions are subject to a fee (in addition to fees from your bank).
COLLECTIONS TURNOVER: $20.00- per date of service sent to collections, in addition to your outstanding balance, you may accrue up to 33% surcharge for legal fees to cover recouping all past due balances with IthacaMed- Accounts not paid within 60 days from due date may be sent to an External Collection agency and reported to the Credit Bureau. In addition, you risk being removed from the practice.
We realize that temporary financial problems may affect payment to your account. If problems do arise, please make sure to contact the office at (607) 277-0969 for assistance. IthacaMed reserves the right to seek reimbursement from any and all of your insurers regardless of whether you provide us with their contact information, unless you instruct us to bill you directly.