PATIENT RESPONSIBILITY DISCLOSURE
As the new year goes on, our patients are being confronted with subtle changes in their insurance plans. Patient responsibility is newly assigned. Commonly, the new year means Deductibles reset and start again at zero. Many of our patients who had no deductibles in the previous year have them now. A large number of them are “not aware” of these changes and in turn it makes it more challenging to collect on these claims which are not paid by the plan since they represent patient’s responsibilities.
For that reason, we some time have to remind our patients that our participation with Insurance Plans does not imply you as our patient will not get a bill for services rendered during your visits or surgical procedures. Note that your Insurance Policy may have multiple ways to assign the responsibility of our fees to you. This is done through DEDUCTIBLES, COINSURANCE and COPAY. It is important to be familiar with these aspects of your plan to avoid unexpected bills and be able to manage your medical costs efficiently and effectively.
DEDUCTIBLES are assigned as per your policy to ALL SERVICES or just to CERTAIN PROCEDURES. Your insurance will not pay for your claims until the total of your deductible has been satisfied by assigning it to approved claims. These DEDUCTIBLES may range anywhere from a total of $200.00 per year to a total of $5000.00 (or more). Note, most often it will take several claims to satisfy a large deductible. As an example, if one visit claim for a patient was around $350.00 and the total deductible is more than that, then your claim for $350.00 may be payable by you, as per your plan’s provisions. Please be aware of this.
CO-INSURANCE is a percentage (%) of your total approved insurance claim which is billable to you as per your insurance policy. This varies widely through the insurance companies. A common CO-INSURANCE is 20% of the approved claim. Normally coinsurance is due after DEDUCTIBLES have been satisfied.
Additionally, a COPAY is a set amount (anywhere from $5.00 to $75.00 or more) collected from the patient at the time of the visit. This is usually stated on your insurance card. Some plans will specify different amounts for your General Doctor and for Specialists.
We hope this helps keep things clear.
We recently took some time to actually talk to some of our Urologists.
As a practice, we all spend a lot of time together. Its that kind of family like relationship, where sometimes you cant stand your little brother, or get annoyed at your dad not letting you go out this or that night. Oh, the memories! After spending some time with our doctors, not interviewing them but just talking to them outside of their Doctor like environment we came to realize how much like you and me they are (yes behind the MD title there is a person too). They are people with the same concerns we have and then some. Namely, taking care of you as a patient and us as their employees.
In the last few months, we have talked to them for some time. While you may think its just urology, its amazing how passionate they are about the cases they are working on and about their trade. Urology, Medicine they’re trades too, also an art in some ways. These require attention and keeping tabs on new techniques and/or medications to treat you know who? You. They sometimes get together over coffee and discuss some of their patients with the other Doctor’s in the practice. They do so with the utmost concern and passion, which sometimes is very inspiring. We as administrative staff may not know the medical lingo the way they do, but its kinda funny to hear them talk about some technique or the other for a surgical case. They are excited about it, about the challenge that those surgical procedures entail and how they’re ready to help YOU beat what ails you. On occasion we’ve asked them how did it go with this patient and his kidney stones, or the other with their bladder tumor? How did it go with that urethral repair? Its great to see them happy with each successful case. As with every thing not all cases have a single treatment solution, but the doctors come back with more information to create the next step in treatment. No, not all cases are surgery. Some are office treatment courses, or studies that help them figure out problems.
On top of having the constant pressure of dealing with their day to day life, they are concerned about you their patient. Besides this, many of our Urologists also lecture at teaching hospitals. It had been our impression that their work day was mostly 9-5 when in the office and which ever surgery cases they had at the hospital. Well, its not just that. Many times they arrive at our office after teaching at the hospital, presenting some conference at 730am. When thinking about that, consider that some of the doctors in our practice come from Long Island or New Jersey!
Medicine is not all glamor. Understanding all they do puts everything into perspective. It takes a lot of sacrifice and dedication, that not many people are willing to make. After coming to this understanding about the doctors at our practice, we have new found respect for them. We may complain sometimes about a stressful day at the office, and that’s fine, but now when we do, we also remember that these doctors we’re working for, never leave the proverbial office because they’re always available in some form to take care of their/our patients.
To ALL Urologists in our practice, and doctors everywhere we have to say thanks for letting us assist in the privilege of caring for your patients!
We’ve received great feedback with our online appointment requests. Many of our existing patients have enjoyed the convenience. If you want to avoid the phone, or being on hold and don’t have an urgent appointment, request it online.
If you are a NEW PATIENT, take advantage of our ONLINE PATIENT REGISTRATION FORM. We need all your information in order to create your account and make your appointment. If you register online, after requesting your appointment, we’ll be able to check your insurance for participation, have your information in our system and even make your appointment and just send you a confirmatory email. It will also save you some time at the office, all you will need to do is review and sign the forms, no more filling them out.
This also benefits new patients whom want to update their information.
Save time, register online!
Snow is such a beautiful thing! Makes everything look so clean and adds this nice serene feel to the scene. However it still causes some delays with transportation and other public services. We’re open and ready to help with your urological problems. Kidney stones don’t wait, urinary frequency doesn’t relent and prostate issues don’t take a break because of the weather.
Be careful in your commute today everyone!
One of the most common challenges for any practice during the beginning of the year is collecting in network deductibles (a set amount of dollars billable to the patient). Most insurance policy deductibles reset on January 1st every year. Many of our patients come to us early in the year, with that concern in mind. Medicare policies thankfully are simple enough, one deductible of $147.00 for the first claim or claims processed during the year.
For private insurance (Aetna, BCBS, Cigna, HIP, Oxford, United Healthcare) is a little bit more complicated. Private insurance deductibles are assigned in different ways, at times we wont know the specifics until a claim is processed. Some policies work like Medicare and deductibles are assigned to the first claim, regardless of the services on it. However, other policies are a bit more intricate and will assign deductibles based on type of service billed. Yes, patients have their booklets that inform them of potential deductible allocations however, this information sometimes is not detailed enough. Even when calling insurance to verify benefits, you wont know that while your policy will not have a deductible for your visit services, it may have it for medical procedures or for imaging services in the same date.
Its important for our patient population to keep in mind, that fees assigned to their Deductibles will be billed to them directly. We advise that they put aside some funds every year (some policies/employers provide Health Savings Accounts for that purpose) to address deductibles in their policies. This way those couple of hundred that might be billed to you will be easier to pay.
If you have any questions, please contact our billing office and we’ll go over your information.
It has been a great year for New York Urological Associates PC. All the doctors and the staff wish to extend all our patients, referring physicians and supporting vendors a warm THANK YOU and wish you all a prosperous and healthy New Year 2014!
2013 was a great year for our office. We welcomed Dr. Marley to our provider roster. We were able to help many patients with their health problems. From simple matters that required minimal intervention and advice to our patients to more complex problems that required lengthy treatments or surgical procedures.
We have to say that kidney stones were the frequent winner in 2013. For some of our kidney stone patients we were able to arrange immediate removal of their stones within our affiliated facilities, while for other patients, we allowed time and medication to enable the stones to pass. We were also able to resolve health concerns for our Prostate Cancer and Urinary Frequency patients.
Our challenges through out the year were not limited to just health care. Our practice as well as other doctor’s offices around the area, have been confronted with administrative challenges. Insurance companies have modified policies. Prescription requirements have become more onerous; we’re trying to keep up with the changes. Now we’re starting 2014 with the advent of the Affordable Care Act and awaiting more information from multiple insurers to see how this fits our current insurance contract. Many of our patients are concerned and so are we.
New York Urological Associates PC welcomes 2014 with open arms, and we’re looking forward to assisting you during the next year.
We’re happy that you have chosen us to resolve your health problems and concerns and strive to provide you with excellent medical care. Our wish is to always improve upon our services to you, our patients, and fix necessary areas. We’re always growing, we’re always changing and adjusting to better serve our community.
Happy New Year!
Our office verifies all insurance policies for our patients. As we go over several accounts, the importance of up to date Coordination of Benefits becomes more apparent. We ask all our patients, new and existing to please provide us with ALL INSURANCE information. This includes our Medicare patients.
On occasion some patients ask “why are you asking for additional insurance? I use only this policy!” It’s important to understand that there are some rules in place when it comes to having multiple insurance policies. Unfortunately, even if we wanted to, as insured parties, we are unable to select which policy to use as primary insurance. When we have multiple policies insurance companies have methods in place to determine which of your policies should be your primary payer and which should be your secondary. These rules apply to all insurance companies and will have to be determined through all insurance policies a patient has. Once all insurance policies agree, then you have successfully setup your coordination of benefits and will know in which order to present your insurance information to your doctors. This process may be cumbersome, but once you have set your Coordination of Benefits correctly, you save yourself and your doctors a lot of future hassle.
One of the issues many practices encounter most often is related to patients who do not disclose all insurance information or were not aware of additional insurance coverage. These cases, while not many, tend to cause the most time-consuming problems from the administrative standpoint. That is without mentioning all the financial liabilities the patient may face. The problems arise when the one insurance the patient “always” used recognized their status as incorrect, after claims had been paid (some times a year after payment). Following this, the insurance would initiate payment recovery procedures with the indication “We paid your claim in error, the patient was insured by XXXXXX at the time of service, please invoice XXXXXX”. At this point it’s sometimes difficult to collect from the “correct” primary payer and we’re then obligated to collect from the patient.
When looking through the patient’s records we find that even though our forms request ALL INSURANCE be disclosed patients show only ONE CARD and fill in only ONE INSURANCE in their intake form. At this point we need to collect from the patient because either their other policy is one we don’t belong to or because it’s now too late to submit claims to another insurance because of timely filing constraints. In an easy case, the affected patient has just the one claim for the year. On an extreme case a patient would have received services from multiple health care providers during a time frame that could span more than a year, now with thousands of dollars to account for.
For this reason we insist that as an insured party, its important that you disclose all insurance information as well as be sure that your policies are correctly coordinated. This includes ALL PATIENTS. As mentioned before, its not our choice which policy is primary payer, our local laws and the insurance make that determination.