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Financial Policy

The purpose of our financial policy is to clearly outline the expectations that have been established to collect patient due amounts, and to open a line of communication between the responsible party and the staff at Graham Medical Group.

Personal Information Updates

Graham Medical Group requires a thorough review of personal information each time the patient checks in for an appointment. The nursing staff uses this information to contact the patient with details related to their medical care. It is very important current information is available so there is little or no delay in contacting the patient and/or caregiver.

The patient or responsible party will be asked to verify that the mailing address and the telephone numbers for the patient and the emergency contact are correct.

The staff at Central Registration will obtain a copy of the insurance card. All insurance cards have specific information on how to obtain preauthorization for procedures as well as mailing instructions for claims processing. It is very important that your physician and nurse have correct telephone numbers to use when contacting the insurance company.

Payment for Routine Care

Many insurance companies do not pay for routine visits. Payment in full is expected at time of service.

Definitions

Self Pay

Any patient who does not have insurance or does not have proof of insurance. Payment is due at the time of service.

Co pay

The amount of money your insurance states is always patient responsibility. This payment is to be made at the time the patient checks in for the appointment.

Deductible

The amount of money the insurance company requires the responsible party to pay before an insurance payment is issued.

Spend Down

For Medicaid patients only: The amount of money the Medicaid program has determined the responsible party must pay before a payment is issued by the program.

Contractual Agreement

A signed agreement between the physicians and the insurance company to accept the approved rates for services. The responsible party will be required to pay the amounts determined to be deductible, co-pay, coinsurance and non-covered services, by the insurance company.

Non Contractual Agreement

The physicians and your insurance company DO NOT have a signed agreement. The Medical Group will NOT accept the rates set by the insurance company.

Payment at Time of Service

Patients who do not have current and valid insurance information when checking in for an appointment will be a self-pay patient and required to make a payment equal to the current price of a Level III (3) visit.

Any additional charges incurred at the appointment will require a payment in full prior to the next appointment.

Patients with current and valid insurance information when checking in for an appointment will be required to pay the set co-payment established by their insurance company if applicable.

Patients with current and valid insurance information when checking in for an appointment will be required to pay 20% of the charges incurred at the appointment. The exception will be for those patients who have a plan coverage that specifically does not require the patient to pay a portion of the charges.

All patients will be expected to pay for charges determined by their insurance company to be a deductible, co-pay, coinsurance and non-covered services, by the insurance company, and patient responsibility in a timely manner. Accounts with patient due balances greater than $500 will be required to make a payment towards the balance at each appointment.

Financial Counselor will be available to review the account with you and complete this transaction.

Forms of Payment

Payments may be made as cash, check, money order, or MasterCard, Discover or VISA credit or debit cards.

Account Statements

Monthly statements will be sent to the attention of the responsible party.

Billing statements related to a child will be sent to the parent requesting the statement. In the event that the balance due is allowed to age with no payment activity, the statement will be sent to the parent with the same address as the child. Once this has occurred the billing statements will not be redirected to the original parent. The Business Office will provide written reconciliation of the account to be used for reimbursement purposes.

Filing Insurance

As a courtesy to our patients, the Graham Medical Group business office will file all insurance claims.

Graham Medical Group is required to file all claims for Medicaid and Medicare patients.

Medicaid patients may be responsible for payment of services. Graham Medical Group will forward these amounts to the patient or responsible party in a timely manner. A Financial Counselor is available to assist you with any questions you may have.

Medicare patients will be responsible for the $131 deductible, the patient due portion, and any non-covered services. As a courtesy to our patients using Medicare, Graham Medical Group will file any secondary insurance. Please remember to have your complete insurance information available at the time you check in for your appointment.

Insurance coverage is a binding contract between the policyholder and the insurance company. Graham Medical Group will file the initial claim as a courtesy. All concerns related to non-payment or reduced payment should be directed to your insurance company. If a claim needs to be re-filed, the Business Office will provide you with an insurance claim form at your request.