Practice Policy & Understandings
The financial aspects of medical and dental healthcare insurance are often very confusing and many times intimidating. Companies differ significantly from one another and different plans within the same company often have great variability.
Over the past few years many changes have occurred within the insurance industry. Essentially, insurance-approved services have been reduced, and insurance companies are collecting large amounts of data about you, which they use to justify authorization of services. These authorizations mean that the insurance company determines the need for services rather than you or your health care provider. After authorizing services, even though your contract with them includes coverage for those services, an insurance company may choose not to pay for those services. Please understand that it is virtually impossible for the average medical and/or dental practice to accurately monitor and be familiar with all the individual requirements of the various healthcare plans. Each has different stipulations regarding services rendered, as well as who may provide those services.
Always remember, your health insurance policy is a contract between you and your insurance company...not between the doctor and your insurer.
OUR RESPONSIBILITY:
* In order to accurately diagnose your condition and make appropriate treatment recommendations, a comprehensive examination must be undertaken at your first appointment. The fee for this examination was communicated to you when you initially contacted our office and is expected to be paid for at the time of service.
*Should you be diagnosed with temporomandibular joint dysfunction and elect to receive treatment at this office, we do have payment options, including Credit Care, available for your consideration. These options will be discussed with you at your first appointment.
If prior payment arrangements have not been made, payment is due at the time services are rendered. We accept cash, Visa/MasterCard, Discover, and American Express credit cards.
*If you elect to submit charges to your insurance company, we will submit the claim on your behalf together with any supporting documentation that may be required. A copy will be sent to you for your records.
*We will provide you with the best possible care available.
YOUR RESPONSIBILITY:
*Be prepared to pay, at the time of your appointment, the fee for your comprehensive examination.
*Please understand that you will be legally bound by whatever payment arrangements are made with our office, and you will be personally responsible for all fees outstanding, notwithstanding pending insurance claims.
*It is your responsibility to familiarize yourself with the type of coverage you have before seeking treatment. Remember, it is your responsibility to know and understand the limits of your insurance coverage, inasmuch as your insurance policy is a legal contract between you and your insurance company-not between the doctor and the insurance company.
*You agree to be responsible for all charges, even those denied for coverage by your insurance company. However, although we will do our utmost to answer any questions or clarify any issues that your insurer may have regarding diagnostic services and treatment procedures, we cannot be held responsible for negotiating claims for services that are deemed non-compensable by your insurance company.
*All collection fees, returned check fees, attorney fees, and court costs incurred will be your responsibility as a patient.
*The parent or legal guardian, who accompanies a minor for treatment, will be held responsible for payment. If you have insurance coverage and plan to have us file your insurance claim form on your behalf, you need to verify whether your insurance company requires you to have a referral from another doctor, or whether they require prior authorization (pre-certification, pre-determination, prior authorization), in order for you to meet contractual policy requirements for payment of benefits. These details will impact contractual reimbursement to you from your insurance company.
*Dr. Steed accepts no HMO/PPO/Insurance Company referrals, inasmuch as such acceptance can be construed as a legally binding contract forcing acceptance of whatever payment the insurance entity deems to be THEIR usual and customary fee(s), and, furthermore, prohibits balance billing the patient. Dr. Steed also does not accept Medicaid or Tri-Care and is a Medicare Opt-Out practitioner. As a Medicare Opt-Out practitioner, neither Dr. Steed nor the patient may file insurance-primary or secondary.
PHONE CONSULTATIONS: Phone consultations with other professionals, i.e., teachers, physicians, dentists, and attorneys are professional services and billed accordingly.
REPORT WRITING: Other than the Narrative Report of Findings sent to your referring doctor, report writing for any other purpose you have authorized to other professionals is a billable professional service.
REQUEST FOR RECORDS: Complying with requests for records from insurance companies, courts, attorneys and schools is a time-intensive endeavor and involves the doctor and staff member reviewing your chart, separating the chart and making copies thereof, together with making copies of X-ray studies. In some cases a brief summary narrative report is requested. These are understandably professional services that are billable.
CANCELLATIONS: Keeping your appointment time is important, inasmuch as the doctor has set aside this time especially for you. Not keeping your appointment or not advising us ahead of time of the necessity of changing your appointment results in a significant block of time that is non-productive for the doctor and staff, preventing other patients from obtaining treatment. PLEASE DO NOT MISS APPOINTMENTS WITHOUT LETTING US KNOW AHEAD OF TIME. ALSO, PLEASE DO NOT CANCEL LATE (LESS THAN 24 HOURS PRIOR TO YOUR APPOINTMENT), AS THIS RESULTS IN THE SAME OUTCOME, If you know you cannot make a scheduled appointment, please call the office as soon as possible.
NSF RETURNED CHECKS: There will be a $35.00 fee for returned checks.
CONSENT FOR TREATMENT: The undersigned has read and agrees to the above policies and further consents voluntarily to treatment and services, to which no guarantee or warrantee is made. If the patient is under the age of 18 years, it is attested that the undersigned has legal custody of the child and is therefore allowed to initiate and consent for treatment. By signature hereunder, the undersigned attests to having received a copy of the Practice Policy & Understandings.
INFORMED CONSENT/ADVOCACY AUTHORIZATION: Should the undersigned direct this office to submit a claim form(s) to his/her insurance company, such request shall authorize this office to act on behalf of the patient in all matters of appeal should the claim be denied. In addition, such authorization shall allow for the submission of the patient's Personal Health Information to any and all interested parties in the attempt to resolve a disagreement and/or misunderstanding, and to clarify the matter so that an appropriate contractual reimbursement for the patient may be obtained.
