PMA - Pulmonary Medicine Associates

EDUCATION

BILLING INFORMATION

Thank you for choosing Pulmonary Medicine Associates. Our group is dedicated to providing the highest quality pulmonary and sleep care. Our staff is devoted to promoting the patient’s overall well being by making your experience as smooth as possible. In an effort to facilitate this experience, we have set up several different departments to assist our patients. The business office hopes the following information will be useful in determining your financial responsibilities and encourage you to review our Financial Policy.

Payment methods include check, cash, Master Card or Visa.

A copy of your insurance card and photo ID are required at every visit.

Payment of any applicable deductibles, co-payments or co-insurance amounts are due before services are rendered. This applies to office visits, sleep studies and other procedures. If you are unable to fulfill this obligation, we may ask you to submit financial paperwork.

If you have no insurance, payment in full is required at the time of service unless arrangements have been made in advance with the Business Office.

If your insurance requires prior authorization or referrals for your office consultation and any visits thereafter, and if this authorization or referral has not been obtained prior to your visit, you will be expected to pay for all charges incurred at the time of your visit. If your insurance subsequently authorizes our services, your payment will be refunded upon receipt of insurance payment. If your insurance requires prior authorization for treatment such as x-rays, labs, MRI, CT etc, our office will work with your insurance company to obtain authorization. It is your responsibility to make sure such authorization is ultimately obtained.

For a full description of how we handle various insurance plans, please refer to the table below to determine what you will be responsible for and what we will do to assist you.

The fee for returned checks is $35.00; this will be added to your account and you may be asked to submit payment in cash, credit card or cashier’s check.

Our office will complete forms for disability, FMLA or Department of Motor Vehicles. Forms will be completed after a $5.00 fee per form is paid. Please allow our staff 7 to 10 business days to complete your forms.

Our business office is here Monday through Friday from 9:00 a.m. to 5:00 p.m. and can assist you with any insurance questions or problems you have. They are your financial advocates and are here to help you understand and follow the financial policies while under the care of our physicians.

Our Practice firmly believes that a good physician/patient relationship is based upon understanding and good communication. Should you have any questions regarding our Financial Policies, feel contact our business office at 775.329.9010.

Office Visits and Sleep Studies
If You Have...	You Are Responsible For....	Our Staff Will...
Commercial Insurance Also known as indemnity, "regular" or "private" insurance or "80%/20% or 70%/30% coverage"	Payment of the patient responsibility for all office visits, injections and other charges at the time of the service.[1]	Call your insurance company ahead of time to determine deductibles and coinsurances. File an insurance claim on your behalf, as well as any claims to your secondary insurance.
HMO & PPO plans with which we have a contract	If the services you receive are covered by the plan: All applicable copays and deductibles are requested at the time of the service. If the services you receive are not covered by the plan: payment in full is required at the time of the service.[1]	Call your insurance company ahead of time to determine copays, deductibles, and non-covered services for you. File an insurance claim on your behalf, as well as any claims to your secondary insurance.
Out of network or Point of service plans	Knowing whether we are a participating provider with your insurance plan. Payment of the patient responsibility - deductible, copay, non-covered services - are due at the time of the service.[1]	Call your insurance company ahead of time to determine out of network benefits, copays, deductibles, and non-covered services. File a claim on your behalf, as well as any claims to your secondary insurance.
Medicare	If you have regular Medicare, and have not met your yearly deductible, we require that it be paid at the time of service. Any services not covered by Medicare are required at the time of service. If you have regular Medicare as primary and no secondary insurance, payment of your 20% copay is required at the time of the service.	File the claim on your behalf, as well as any claims to your secondary insurance.
Medicare HMO	All applicable copays and deductibles at the time of the service.	File the claim on your behalf, as well as any claims to your secondary insurance.
Worker's Compensation	If we have verified the claim with your carrier, no payment is necessary at the time of the service. If we are not able to verify your claim, payment in full is required at the time of the service. If and when we receive payment you will be refunded your portion.	Call the carrier ahead of time to verify the accident date, claim number, primary care physician, employer information and referral procedures.
No Insurance	Payment in full at the time of the service.	Provide financial counseling in the case of a financial hardship.

[1] Patient responsibility may vary from what was quoted when eligibility and benefits were verified with insurance once payment is received.