CalSpine MD / Hieu Ball, M.D., Inc., has adopted the following financial policies to simplify the billing process and help secure reimbursement for your medical services.
Bring Your Insurance Card To Every Office Visit
You must bring your insurance card on your first visit, as well as any time your coverage changes in any way. Always be sure to tell us right away when you get new insurance coverage or updated information. It is your responsibility to determine that we are contracted providers with your insurance carrier before being seen. We are not responsible for any changes in your insurance coverage.
Update Your Address, Telephone, and Employer Information
Please call our office at (925) 838-8830 if your address, telephone number, and employer information change prior to your next appointment.
Insurance Co-Payments Due At The Time Of Service
If your insurance policy requires you to pay a co-payment for our office visits, you will be asked to pay that co-payment at the time of the appointment.
Verifying Your Insurance Coverage
If we cannot confirm that you are covered by an insurance plan, you will be expected to pay the charges in full at the time of the visit. Upon receipt of confirmed insurance coverage, we will bill the insurance company. When we receive an insurance payment, we will remit any monies that have been rendered by you that exceed the contractor allowable.
Auto Accident/Other Injuries
We do not bill third-party insurance. If you have been injured in an auto or other accident, you must inform the front office staff. You will be responsible for payment in full at the time of service.
Delayed Insurance Payments
If you have commercial insurance, we will bill your insurance carrier as a courtesy to you. If your insurance carrier does not make payment within 90 days, the balance will be due in full from you. If there is a problem or a dispute over the payment with the insurance carrier, we will ask you to pursue the matter with them directly. If your insurance carrier subsequently makes a payment, we will remit any monies that have been rendered by you that exceed the contractor allowable.
Denied Insurance Claims
If your insurance company denies a claim, you will be billed for all services not covered in accordance with the contract with your insurance company. This may include but is not limited to, denials due to eligibility, out of network services, non-covered services, and instances where maximum benefits have been reached.
Workers’ Compensation Cases
If you have a workers’ compensation case, you need to bring all of your insurance information with you to your appointment. If the claim is denied, the charges will become your responsibility.
For your convenience, we accept Visa, MasterCard, and Discover Credit Cards. In addition, we may be able to make arrangements for monthly payments on your account. Please contact our office in advance if you have any questions regarding your payment options.
Missed Appointments and Cancellations
If you must cancel or reschedule your appointment, please notify us 24 hours in advance. Failure to do so will result in a $25.00 service charge. This is a non-insurance covered charge.
Completion of Forms
We apologize for this change, however, due to the increasing demands for completion of paperwork, and distraction of direct patient care for doing the same, as of January 17, 2007, our practice, CalSpine MD, will be charging patients for completion of their disability forms. The following fees will be charged and collected prior to or upon delivery of completed forms:
State of California Disability Forms: $15.00
Department of Motor Vehicle Form for Disability Placard: $15.00
Ancillary and/or Insurance Forms:
1-2 Pages $25.00
3-5 Pages $50.00
6-10 Pages $75.00
In Excess of 10 Pages $12.00 per additional page
There is a charge for copying materials from your medical record, including the transfer of records to an attorney, other physicians, and other medical facilities. This request must be made in writing. The fee for copies of medical records is $25.00. If there are numerous pages, the fee may be greater than $25.00 and will be assessed at the time of the request. This is a non-insurance covered charge and must be paid in full prior to copies being made. We accept personal checks or cash only for this service.
*Please Note: Requests for copies of x-rays taken in our office will be copied for you onto a CD-ROM disc upon a 48-hour advance notice request. The fee for the copy of x-rays is $15.00 and must be paid in full in the form of personal checks or cash only for this service. This is a non-insurance covered charge.
It is your responsibility to keep your account current. All charges are due in full at the time of service or upon receipt of a statement. We are not responsible for delinquent accounts due to the lack of receipt statements or other correspondence. Notices are assumed to be received despite them being returned to us as unclaimed, or otherwise undeliverable. Accounts outstanding over 90 days may be submitted to an outside collection agency.
Our staff is available to assist you Monday through Friday from 9:00 am – 5:00 pm. We are closed for lunch from 12:00 pm to 1:30 pm. Please do not hesitate to contact us if you have any questions at (925) 838-8830.
I have read and understand the above information. I also understand that no guarantee has been made to me about my insurance coverage and I do not hold CalSpine MD / Hieu Ball, M.D., Inc. or his staff responsible for my insurance coverage, pre-authorizations, or other insurance decisions.
*Please Note: The patient is NOT responsible for ANY BALANCES as long as workers’ compensation insurance is accepting responsibility for the current claim.