Insurance & Billing
Our friendly business office will gladly assist you with your insurance requirements, physician referrals and payment for services. However, it is ultimately your responsibility to be aware of your insurance coverage and financial obligations.
Fees
We have set our fees with a goal of being reasonable and fair. They have been aligned with Medicare’s Resource Based Relative Value Scale and geographically adjusted for orthopedic specialists serving the Northwest Montana region.
Insurance Plans That We Participate In
All of our physicians participate with MEDICARE, MEDICAID, and many private insurance plans (see plan list below – as of February 1, 2009). We will bill these insurance companies on your behalf and make every effort to resolve any billing problems that arise. Our reception staff will be happy to provide you with more information when you call for an appointment.
PLEASE NOTE: Insurance plan contracts change frequently and it is possible that this list may not be 100% accurate. We try to update our website regularly, but it is always best to confirm that we participate with your insurance when making your appointment.
• Blue Cross and Blue Shield of Montana
• Champus
• Clear Choice
• Community Health Network
• Coventry/First Health Network
• GEHA
• Health Info Net
• Indian Health Services
• Interwest
• Medicare
• Montana Medicaid
• New West
• Workers Compensation
• Montana Health System
• Montana State Fund
• United Healthcare
• Blue Cross/Blue Shield of Montana
Other Insurance Plans
There are also many insurance plans that we do not contract with to be plan providers. This may be because of unacceptable contract provisions, insufficient “covered lives” in our service area, or it may be an “open plan” that does not contract for services. As a courtesy to our patients, we will still bill these insurance carriers on your behalf.
Co-pays and Deductibles
Many insurance plans require that we collect co-pays and/or deductibles from the patient. By law we cannot waive these fees. MEDICARE has enacted tough penalties for providers who do not make a diligent effort to collect these payments from the patient.
Referrals and Preauthorization
Many private insurance plans require referrals and/or preauthorizations for some types of services. Because of the multitude and complexity of plans, our office may not be aware of the requirements of your particular health plan. We strongly advise that you read your plan materials or consult with the plan’s customer service department to determine if there are any special requirements. If you do not get the necessary referrals or preauthorization, the insurance company will often refuse to pay the bill and you will be responsible for payment. In some cases it may be necessary to reschedule your appointment until the required referral or preauthorization is obtained. We will be glad to assist you in obtaining these items and answering any questions that we can.
EOB’s and Statements
In most cases you will receive an EOB (Explanation of Benefits) from your insurance carrier outlining what was billed and what was paid. The EOB should also provide an explanation of any amounts that you owe. There are many different formats and codes used by the various insurance companies. If you have questions regarding the information contained on your EOB, it is usually best to call the member services department at the insurance company. If you have questions about the services shown on the EOB, please call our business office.
If there are unpaid balances on your account, you will receive a statement from us, even if we are billing your insurance company. Items pending from the insurance company will show on your bill, but should indicate that we are waiting for payment from them. If you have questions about your statement please contact our business office.
Payment Plans
If you are uninsured or are responsible for a portion of your bill, you will be expected to make payment at the time of service. If you cannot pay for your care at the time of your visit, please contact our billing office prior to your appointment to determine if you qualify for a deferred payment plan. Our staff will work with you to arrange a reasonable payment schedule for the services you require.
Refunds
In the event that an overpayment or duplicate payment is made, we will make a refund to the patient or insurance company in a timely manner.