Moscow Family Medicine (MFM) is committed to providing the highest level of quality medical care and personal service to our patients. For every commitment, there is an obligation. We feel it is the responsibility of the patient or guardian(s) to meet their financial obligations.
As we see many patients from many different insurance plans, it is impossible for us to know all the covered benefits, co-pays and deductibles for each plan. In addition, your insurance company does not guarantee payment to us. While it is our intention to assist you, it is your responsibility to ensure that all services rendered or referred by MFM on your behalf are paid in full and in a timely manner.
In order to clarify MFM’s Financial Policy, below are our financial requirements.
Patients Without Insurance Coverage (Self-pay) and New Patients (including patients who have not been seen by MFM in the last three years):
Payment in full at the time of service is expected. We offer a 15% discount for all self-pay patients paying in full at the time of their visit. If absolutely necessary, short-term payment plans are available. Payment plans must be requested prior to services being provided.
Contracted, PPO and HMO Patients that have a Co-payment and/or Deductible:
As a courtesy, we will bill your insurance company for services provided. MFM requires that you present your insurance card and co-pay (as required by your insurance company) at every visit. This allows us to ensure we have accurate and up-to-date information for billing purposes. If you do not have your card with you, you may be asked to reschedule your visit or you have the option of being set up as self-pay and paying in full at the time of service. If your insurance plan has an annual out-of-pocket deductible you are expected to advise us of this and pay in full at the time of service until the deductible is met. Once your claim is processed by your insurance, any additional co-insurance, deductibles or non-covered services will be due upon receipt. If your insurance changes please let us know as soon as possible.
As a courtesy, we will bill Medicare for you. You will receive a statement of these charges after Medicare has processed the claim. If you have supplemental insurance to Medicare, we will also bill your Medicare supplement for you. You will receive a statement from our office after Medicare and your secondary insurance have paid their portion or applied any applicable charges to your deductible. Occasionally, Medicare supplemental insurances will pay the payment directly to you. In this case, please contact our office immediately or send the check to us so that we can keep your account current.
Non-contracted Insurance and Private Insurances:
As a courtesy to all our patients, we will bill your primary insurance for you. However, you are responsible for full payment of any charges insurance doesn’t cover. You are expected to pay in full at the time of service. We do not accept Molina Insurance, Community Health Plan, Washington Medicaid or Workman’s Comp. claims from federal or states other than Idaho and Washington. We do not take any health insurance from outside the U.S. If you are unsure whether your insurance is contracted with our office, you will need to call your insurance company and verify that information prior to your visit.
Auto Accidents, Civil Suits, Home or Business Owner’s Claims:
Due to the often lengthy resolution of these claims, you are expected to pay in full at the time of service. We do not bill third party insurances.
Worker’s Compensation Claims:
If you are being seen for an injury that occurred during the course of your employment, please be sure to notify the receptionist that your injury is “work-related” so we can ensure the appropriate paperwork is completed. We are contracted with the Idaho State Insurance Fund and the Washington Department of Labor & Industries. If your employer is self-insured with another carrier, please bring the appropriate paperwork with you from your employer and notify the receptionist of the correct carrier. Please check with this carrier for any restrictions regarding who you may see for your injury/claim. Please be advised that our office is required by law to report all work-related injuries. We cannot choose not to report the accident if we have knowledge that it is work-related. If your employer or their insurance carrier denies the claim, you will be held financially responsible for all charges.
Routine obstetrical care visits and delivery are not billed out until after the delivery. Please make an appointment with our Financial Counselor to determine an estimated out of pocket expense based on the covered benefits of your insurance plan.
We will work with you to set up a payment plan. You will be required to make monthly payments during your prenatal care for any amount not covered by your insurance company with the intention of having the estimated portion due paid prior to delivery. Please refer to the Obstetrical Care Policy for more detailed information.
Laboratory (Lab) and Other Ancillary Services:
MFM provides many lab services in the office. Lab charges for tests done in house will be added to your bill. In addition, at times, test specimens are collected here and sent to an outside lab or pathologist for processing. Services not performed in house are billed to you separately by the lab or pathologist providing the service on a separate statement of charges from that service provider. Examples of both in house and outside lab services include procedures such as: urinalysis, blood tests, pap smears and pathology for special tests or screening ordered. Other in office procedures, such as EKG’s, immunizations and other injections, are billed separately in addition to the office visit. Radiology services are provided by Gritman Medical Center and you will receive a separate bill from them for those services.
Minor surgeries and procedures are billed differently than routine office visits. You are responsible for knowing your health insurance benefits for procedures. Please be prepared to pay the charges your insurance does not cover. A minor surgery or procedure could include, but is not limited to, wart removal, lesion destruction, biopsy procedure, incision and drainage, laceration repair, toenail removal and ear wash.
Students and Short-term Patients:
If you would like, we can send your statements and any correspondence to an alternate address within the U.S. (i.e. parent’s or permanent address). However, the mail will be addressed to you if you are over eighteen years of age and you will be held financially responsible for any charges incurred. In addition, you will also be responsible for paying any co-pays at the time of service. All unpaid balances for services provided at the Student Health Services clinic will be transferred to your student account and will be due to the University of Idaho.
Administrative Fees: Effective September 1, 2012
There will be a $25.00 “No Show” fee for all no show appointments.
You may be charged a $25.00 cancellation fee for visits cancelled on the same day as your appointment.
NSF checks will be charged $30.00
If your account is sent to collections due to non-payment, it will be referred to:
Chapman Financial Services, Inc. 1-800-876-2328
In addition, MFM reserves the right to terminate the doctor-patient relationship if your account is sent to collections.
Defining Wellness vs. “Problem” Visits:
It is your responsibility to know your wellness benefits before scheduling.
Our policy is to act in accordance with federal guidelines and ethical standards in billing appropriately. Wellness appointments (i.e. preventive medicine or yearly physical exam) will be submitted as a wellness exam to your insurance. Depending on your health plan’s policy, your insurance may or may not cover this visit. Not all insurance companies cover well visits; or, you may have a maximum annual cap.
If, during the course of your wellness exam, the physician addresses and documents a problem-related issue (i.e. hypertension, depression, diabetes, pain, acne, etc.), you may receive a second office visit charge that includes any additional lab work that may be required. National billing standards require these issues to be billed separately. In addition, your insurance may require you to pay two co-pays for the visit because of the well visit and problem visit charges on the same day. You may be asked to schedule a separate appointment for those issues not related to the wellness visit.
The physician assigns codes according to the service provided. The doctor cannot alter the coding submitted to your insurance in order for your insurance carrier to make payment.
Payment will be requested at the time of service for all services which are non-covered or determined to be the patient’s responsibility, including co-payments and deductibles. Payment may be made by cash, check or VISA.
If you have a question regarding insurance, billing or our fees, please call our Business Office at 208.882.4611.