Financial Policies

Patient Billing / Insurance Department

WITH YOUR HELP WE CAN MAKE A DIFFERENCE!!!! That's our motto. Providing us with accurate information at the time of service facilitates the filing of claims and reimbursement. As you know health care insurance has become a complicated business and the processing of insurance claims in managed health care is difficult. Your cooperation in providing us a copy of your insurance card when requested, will allow us to process your claim correctly.

The Urology Team P.A. participates in most managed care plans; however, not all of our doctors are in all of the plans. Because insurance plans are constantly changing, we encourage you to read any booklets you may receive and talk to your employers plan administrator. Your insurance contract chosen by you or your employer defines the extent that services are covered. We encourage you to be well informed about your health insurance plan. Many of these plans have a specific dollar or percent of charges co-pay, in and out of network requirements. We may have to call you in the event that we experience problems with your insurance company.

Other points of interest

1. Payments may be made by cash, check or credit cards.
2. If you are a private pay patient, The Urology Team requires a deposit of $150.00 prior to seeing the MD. (please see self pay policies)
3. Returned check fee and unpaid checks will be turned over to the District Attorneys office.

Past Due Accounts

Patients who have not made an effort to make or maintain payment arrangements or have not expressed an interest in meeting their financial obligation to us may be turned over to a collection agency and reported to the credit bureau and to the Attorney General's Office of the State of Texas. Accounts that are over 90 days old may be assessed with a 1.5% finance charge. Any balance amount over 90 days old must be paid in full before new charges may be added to the account.

To learn more about our expectations, read the Financial Responsibility and Policy Sheet.

Procedures Performed in Office

As a courtesy to our patients, we accept and file claims for numerous insurance plans but do not know in advance how each and every insurance carrier handle the charges for procedures. In- office procedures are not subject to prior authorization, but when possible the Urology Team does make every effort to obtain information regarding scheduled procedures such as Vasectomies, Biopsies, BPH treatments (Microwave Therapy), Urodynamics, scheduled medications. It is very important that you understand your insurance plan and when you have a scheduled procedure call your insurance company if you wish to know whether or not a given procedure is subject to your deductible or co-insurance. The Urology Team provides that service as a courtesy, but ultimately, it is your responsibility. We will be happy to provide you with procedure codes and diagnosis codes that you may need to know should you decide to call ahead. Be sure to ask under what circumstances the procedure would or would not be covered and whether or not you have a surgical deductible. We advise that you get the name of the person to whom you speak. For unscheduled procedures which are often determined necessary by your physician at the time of a scheduled visit, we do not call your insurance company to verify coverage before the service is provided.

Pathology Specimens

We send tissue biopsies (Prostate Biopsies, Vasetomy vas deference, Skin samples) to Uropath or if indicated to your approved lab via your insurance. All other specimens are sent to you assigned lab.

Self Pay or No Insurance

Patients without insurance coverage will be asked to make payments at the time of service, unless the business office manager has approved other specific arrangements. If you are a private pay patient, the Urology Team requires a deposit of $150 prior to seeing the doctor. It is very important to ask your MD about the cost of services recommended prior to the service being provided. After seeing the doctor, you will be asked to pay any additional amounts due for services rendered or you will be refunded any overpayment if the charges are less than the $150.00 payment.

Medicare

The Urology Team will file all claims for patients on whom we have a Medicare number registered. Since The Urology Team participates with Medicare, the payments will come directly to our office. You will receive a Statement from Urology Team after your primary and secondary (if applicable) insurance have paid their part. Should your insurance company deny service, we will appeal. This appeal will delay your receipt of your final statement. At this point and after we have exhausted every measure possible, you will receive a statement reflecting an amount you owe for your deductible or co-insurance.

Medicare as Secondary Insurance

If Medicare is the patient's secondary insurance coverage, The Urology Team will file the primary insurance. We will then file your supplemental Medicare for you and coordinate benefits with your secondary insurance carrier.

Co-Payments

Office co-payments are due at the time of service each time you visit the physician.

If an HMO patient follows the referral or authorization guideline before their visit to a specialist (i.e. Urology Team), medical necessity and the service is a covered service as determined by your insurance company. The only fee you may have to pay is the co-payment.

Unless otherwise stated by your insurance company, all other insurances have:

• Co-payment for visits
• Encounter Fees
• Yearly Deductibles/Annual out of pocket
• Must meet medical necessity established by your insurance company
• Must be a covered service

IN OTHER WORDS, THE AMOUNT YOU PAY DURING YOUR VISIT MAY NOT BE ALL YOU OWE. Your final responsibility will be determined after your insurance company has processed and paid your claim. At that point, Urology Team will bill you the outstanding balance.

Referrals or Authorizations

One of the primary goals of managed care is to contain cost by eliminating inappropriate use of the medical system. To do this, many insurance companies utilize a "gatekeeper system", which requires that evaluation of a medical problem originate with the designated PCP or primary care physician. Managed care limits an authorization for specialists care either by time, or number of visits and that is why it is so important for you to become educated about your health insurance. Your insurance company also has entered into contracts with certain diagnostic centers for services. This may limit your options as to what lab or imaging center you can use. It might be best to call your insurance carrier (number on the back of your card) to verify whether you need a referral to see our physicians. It is very important that you know who participates with your plan.

At your first visit we will ask you for your referral if needed for your insurance company. If you return and your visits extend past their original limits, you will need to contact your PCP or insurance company to request an extension before being seen. Most insurance companies require at least 24 hours to get you your approval. If you are a member of such a plan, we will be able to see you only with the required referral information or have you prepay for services.

Questions Regarding Fees

We welcome inquiries regarding surgery or other medical care and encourage such inquiries before the care has been rendered. This question can be made directly to the billing department on our Contact Form.

Insurance Cards

Please be prepared to show your insurance or other medical assistance card every time you are seen. We will verify your insurance information and keep a copy of the card on file.