Filing Insurance: If you carry insurance, Sensenbrenner Primary Care will file claims on your behalf to insurance companies that we are contracted with. If Sensenbrenner Primary Care is not contracted with your insurance company, payment in full for services rendered is due at the time of service. We will be happy to assist you in filing a claim to your insurance company by providing you with the necessary ICD10 and CPT codes required by most insurance companies. We will bill you for the remaining portion of your balance, if any, once all insurance payments have been received.
Self-Pay (No Insurance): Payment in full is expected at the time services are rendered. Upon checking in at the front desk, you will be expected to pay a $100.00 pre-payment. At check-out, the provider will indicate what services were rendered and the balance of your visit is due prior to leaving. If the services total less than $100.00, you will be refunded the difference.
Balances on Accounts: After your insurance has paid (or denied) your visit, there may be a balance remaining. We will send you a statement monthly for any balance due on your account.* Any patient who owes a balance on his or her account must be prepared to pay the balance due upon arrival at his or her next appointment. Failure to do so can result in cancellation of the scheduled appointment. If you are unable to pay the balance in full, you need to contact the office as soon as possible to make arrangements. Unpaid balances over 90 days will incur a $5.00 monthly account maintenance fee (beginning with the 4th statement).
*Once an account is transferred to “internal collections”, statement activity will cease.
Payment/Statement Options: After your insurance has paid (or denied) your visit, there may be a balance remaining. We will send you a statement monthly for any balance due on your account. For the time being, we are mailing statements. The patient portal may be offering us the option to send electronic statements in the near future. Please do not call to make payments over the phone. You can pay your bill by mail or online. To pay online, visit our website at www.sensenbrennerprimarycare.com/PAY and pay directly without any additional logins or passwords.
ACH Check Conversion: When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic funds transfer from your account or to process the payment as a check transaction. When we use information from your check to make an electronic funds transfer, funds may be withdrawn from your account as soon as the same day you make your payment, and you will not receive your check back from your financial institution.
Returned Checks: Sensenbrenner Primary Care will charge $25.00 for any returned checks. Payment in full (amount of check + $25.00 fee) is due ten (10) days after we contact you regarding the check. Payment on returned checks must be paid with cash, Visa or MasterCard only. We will not accept a check to cover the returned check. Repeat offenders will not be permitted to pay with checks. We also reserve the right to dismiss repeat offenders from the practice.
On Call Service: Sensenbrenner Primary Care offers an on-call service for its patients the days and evenings the office is closed. This service is for established patients and is to be used for serious medical concerns only. The on-call service WILL NOT do the following: refill medications, phone in narcotic medications, or answer non-critical medical questions (i.e. check on referrals, discuss test results or medical conditions). Persons who abuse the on-call service with non-clinical inquiries may be subject to a charge.
Missed Appointments: If you cannot keep your appointment, you must cancel 24 hours prior to your scheduled appointment. As a courtesy, we will attempt to contact you two business days prior to your appointment to remind you. However, it is ultimately your responsibility to keep up with your appointments. Missed appointments or appointments canceled with less than 24 hours’ notice will incur a $50.00 fee. You may be dismissed from the practice for excessive no-shows or cancels with less than 24 hours’ notice.
Formulary Benefits Data: Formulary benefits data are maintained for health insurance providers by organizations known as Pharmacy Benefits Managers (PBM). PBM’s are third party administrators of prescription drug programs whose primary responsibilities are processing and paying prescription drug claims. They also develop and maintain drug formularies, which are lists of dispensable drugs covered by a particular drug benefit plan. Sensenbrenner Primary Care will access my pharmacy benefits data electronically through RxHub. This allows us to: 1) Determine the pharmacy benefits and drug co-pays for a patient’s health plan 2) Check whether a prescribed medication is covered (in formulary) under a patient’s plan 3) Display therapeutic alternatives with preference rank (if available) within a drug class for non-formulary medications 4) Determine if a patient’s health plan allows electronic prescribing to mail order pharmacies, and if so, e-prescribe to these pharmacies 5) Download an historic list of all medications prescribed for a patient by any provider.
Forms, Letters, Handicapped Tags: You may require forms or letters to be completed by a provider. Completion of forms requires administrative time to gather data, physician time to review and time to complete the form. We have an established form completion policy. We are not obligated to complete these forms. We reserve the right to refuse to complete any form. If records are requested, in addition to a completed form, then the form will be sent from our office once payment has been received from the company requesting this information. No forms or records will be sent to a third party without a signed release from the patient.
- You must be an established patient, we cannot complete forms until you have been seen in our office at least 3 times.
- Forms cannot be completed on the day presented to the office unless you have scheduled an office visit specifically for forms completion. When you schedule your appointment, inform the scheduler that you have forms.
- Blank forms will not be accepted. Personal information needs to be completed.
- Forms are completed for those accounts in good standing. Outstanding balances need to be paid prior to forms being filled out.
- Many forms require a current examination prior to being completed. If this is the case, you will be notified and asked to schedule an office visit. You will not be charged for both the office visit and the form completion. Please understand that your insurance may not cover an office visit for form completion and if they do not, the charge is your responsibility.
- If you have seen a provider within the past 3 months, then you may leave the forms and a provider will complete them and return them to you.
- All forms and letters require seven (7) business days to complete.
- Fees for letters requested on SPC letterhead for medical necessity (including but not limited to):
- Jury duty: $25
- All other letters requested based on content: $50-$100
- Fees for form completion (including, but not limited to, disability, FMLA, DMV, FL2, DME, biometric screening, insurance review, etc.):
- 1 page: $25
- 2-5 pages: $35
- 6-10 pages: $50
- 10+ pages: $100
- Fees for handicapped tags/parking permits: $25 (Please note SPC will consider a handicapped tag ONLY if the patient is wheelchair bound, on crutches or a walker or is on continuous oxygen therapy)
Portal: To enroll in patient portal, just give us your email and we’ll send you the link to complete your enrollment. You can view lab results, allergies, medications, past medical history, vitals, appointments and request refills. To visit the portal directly visit https://healthportalsite.com/SPC. (Please note: Prescription refills should be requested through your pharmacy. Never use messages for time sensitive communication or emergencies. The healthcare providers may only have time to check their messages at the end or beginning of a busy day. Expect at least 48 hours before receiving a response. Messages left on Fridays may not be answered until Monday afternoon. Please respect the limited time that providers have to respond to the many messages they receive each day. Medical questions requiring complex medical decision making may be subject to a charge. We reserve the right to limit the quantity of messages sent.)
What’s not covered at 100 percent?
Here are some services your doctor may order that are not considered preventive care and which may lead to more out-of-pocket costs:
- Problem focused visits (if new symptoms are discussed or changes to your existing conditions are made you may be charged for both the preventive physical exam and the problem focused office visit)
- Thyroid function
- Vitamin D
- Vitamin B
- Testosterone or other hormone levels
- Urine microalbumin
- Chest x-ray
- If you do not want any of these lab tests performed, please let your provider know before heading to the lab
How to avoid extra costs
- When you make your appointment, say that you want preventive care screenings and tests
- Ask if any tests or treatments done might not be considered preventive care
- Ask if discussing other topics, that are not considered preventive care, during your appointment will lead to extra out-of-pocket costs
- Ask if any lab work can be sent to an in-network lab to lower any out-of-pocket costs
- Understand that health plans will pay for one wellness or preventive exam per year. Your insurance provider may consider this to be once per calendar year or one year and one day since the date of your last wellness exam. If you have had any other visit billed as preventive during this time period your plan is likely to deny your wellness exam. This could include a well-woman exam or annual pap smear. It is the patient’s responsibility to check with their insurance provider to see what is covered under their wellness benefit and to ensure they are eligible prior to scheduling their annual wellness exam
Why this change?
Several health plans, including BCBS NC and United Healthcare, have policies outlining what preventive services are covered. They follow US Preventive Services Task Force (USPSTF) recommendations and guidelines established in the Patient Protection and Affordable Care Act (PPACA). Find more information at their websites. Also visit your health insurer’s website for information on their preventive service guidelines and medical policies.