CROMWELL MEDICAL CLINIC PLLC FINANCIAL POLICY
In order to accept health insurance, Cromwell Medical Clinic PLLC is bound by the contract terms of our individual and group contracts with various health insurers including, but not limited to, Medicare, Medicaid, Tricare, Champ VA, and all commercial insurers with which we hold a contract agreement. As part of the terms of these contracts, Cromwell Medical Clinic PLLC agrees to accept the contracted rate from each insurer as reimbursement for eligible and medically necessary services performed. Cromwell Medical Clinic PLLC is entitled to collect from patients the patient responsibility as determined by the payer’s Explanation of Benefits in accordance with the patient’s insurance policy and coverage once the payer has received and processed our claim for services provided.
It is the patient’s responsibility to provide active and valid insurance information to the Cromwell Medical Clinic on or before the date of the appointment, or within 30 days of that date if such coverage is pending at the time of the visit. Failure to do so will result in the patient being billed for the entire balance.
Cromwell Medical Clinic cannot waive or discount copays, deductibles, or coinsurance balances or accept reduction in payments from patients if an insurer has determined a balance is patient responsibility. Further, we cannot honor requests to defer billing to an insurance company if a patient only wants to reduce patient liability unless the contract between Cromwell Medical Clinic and the payer expressly allows for such variations. It is the patient’s responsibility to determine that ahead of the visit if they wish to request a variance from standard billing procedures. If a service or procedure is found to be non-covered by the insurance policy, the patient will be billed at the cash-pay rate if payment in full is made within 10 days of the date of service.
For uninsured patients or patients who have insurance coverage with an entity that does not hold a contract with Cromwell Medical Clinic, patients will receive a self-pay discount if payment in full is received within 30 days of the date of service.
Failure to disclose if a visit is related to a workplace accident or injury or an accident or injury sustained as the result of an automobile or other accident at the time of the visit may result in the balance being denied by insurance and will therefore be the sole responsibility of the patient.
Cromwell Medical Clinic utilizes the billing services of Athenahealth, which is the same entity that our Electronic Medical Record System (EMR) is housed in. Athenahealth performs all billing, including mailing and sending electronic statements, and is able to accept all payments either online or by mail. Payments will also be accepted at the Cromwell Medical Clinic, 5568 Clark Avenue, Suite 1, PO BOX 116, Cromwell MN 55726 OR the Maine lockbox as shown on your patient statement. Cromwell Medical Clinic will also accept credit card payments via telephone. Athenahealth sends four (4) patient statements after a patient balance has been determined. If no payment has been made, no additional charges have been incurred, or no payment arrangement has been established between the patient and the Clinic, Athenahealth will no longer mail a paper statement and the balance will be considered in collections. Cromwell Medical Clinic reserves the right to turn over past due and collection balances to a third party collection agency once a balance is 180 days delinquent. Individualized payment or prepayment plans may be required to address delinquent balances and avoid scheduling delays for future visits.
Telehealth services are considered billable and are subject to the same deductible, coinsurance and copays as standard in-office visits if deemed eligible and medically necessary by the insurance payer. Non-verbal or non face-to-face electronic communications, including but not limited to emails, text messages, private messages, Facebook or other social media messages, or Patient Portal messages are considered billable to insurance and MAY result in patient financial responsibility if they fall within the insurance company’s threshold of what is deemed eligible and medically necessary.
Lab services that are performed by Cromwell Medical Clinic and sent to Quest Diagnostics for processing will be billed directly to the patient/insurer by Quest Diagnostics. It is the patient’s responsibility to determine network status with Quest Diagnostics prior to services being incurred. Cromwell Medical Clinic has limited access to Quest Diagnostics billing and claims once a service has been performed, and it is often difficult to make changes to coverage and coding retroactively.
In accordance with new legislation effective 10/1/2024, any increase in patient responsibility discovered after the fact and due to a billing error will be communicated to the patient within 30 days of discovery of the error, regardless of when the date of service occurred. Details of the steps necessary to confirm, dispute, remedy or resolve the issue will be outlined in that notification.
If you have any questions about coverage of services or our financial policy, please ask or call BEFORE you are seen by the provider.