Before seeing one of our physicians, we recommend that you contact your insurance provider regarding coverage of services at Ortho NorthEast. Because so many variables exist with insurance plans, knowing your coverage will help insure that you are not left responsible for large out-of-pocket expenses.
If provided with complete billing information prior to your service, we will submit a claim directly to your insurance company for processing. However, the responsibility for payment for services rendered rests directly with you. If payment is not received from your insurance carrier within sixty (60) days of billing, you may be asked to contact your carrier to resolve the issue. If there is still no payment within ninety (90) days, you will be asked to make full payment for the services rendered.
It is important to realize that many insurance companies do not cover the full amount of physician charges. There often is a deductible and/or co-insurance amount due from the patient. Insurance companies use the term UCR -- an acronym for usual, customary and reasonable -- to describe how they determine the amount of your doctors' fee your policy will cover. Insurance companies set their own UCR levels based on a variety of considerations, including their desire to minimize costs. UCR is not a calculation of "normal" or "usual" fees charged in the area. Amounts not covered by your insurance company due to UCR will need to be paid by the patient.
Notice of Financial Interest in Health Care Entity
Your treating physician and other physicians at Ortho NorthEast (“ONE”) is/are a part-owner(s) of ImagingONE, SurgeryONE, TherapyONE, and the Orthopaedic Hospital at Parkview North, LLC. The physicians believe these facilities may be an appropriate setting for your medical care. Nevertheless, the selection of a specific health care provider always rests with the patient, and you may choose to be referred to an alternate setting if you so desire.
Liability / Injury Cases
Payment of the bill is the responsibility of the individual who has received the treatment, not the individual who is being sued. For this reason, as well as the fact that lawsuits may go on for a protracted period of time, our bill should be settled promptly or payment arrangements should be made with our collection department.
Medicaid
Providing we have the correct information, your claim will be filed directly with Medicaid. If your plan requires referral from a primary care physician and/or prior authorization, you must follow those requirements. Failure to do so may cause a delay in your continued service. Spend down amounts are due upon notification.
Medicare
Providing we have the correct information, your claim will be filed directly with Medicare. We do accept assignment; deductible and co-insurance amounts will be billed to your secondary insurance carrier if information is available, or to you if there is none. You may be asked to sign a form (waiver) stating that you will be responsible for other services rendered that Medicare may consider to be unnecessary. Non-covered services will be billed to the patient, as well as any services that may be denied and for which a waiver form was signed at the time of service.
Worker's Compensation
If a patient advises that medical services are related to a worker's compensation matter, we will obtain verification of this from the employer. Submitting already identified case numbers from the Industrial Board will aid in processing your claim. Because many worker's compensation cases are denied after review, we will also obtain your medical insurance information. For more information about worker's compensation, please call our office at (260) 484-8551 and ask for the worker's compensation department.
Patients with no insurance coverage are expected to pay in full for services as they are rendered. Payment in full for services on the day of service may be eligible for a discount. If surgery is elective in nature, payment must be made prior to the surgery; this too may be eligible for a discount.
No Insurance
If you would like to discuss the possibility of a payment plan or assistance based upon our guidelines for indigent care, please call our collections department at (260) 484-8551 ext. 2405.
