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Billing
and Insurance
Our Charges and
Payment Policy
To learn about our charges, how we bill your insurance,
and payment obligations, please read our
financial policy.
Please do not hesitate to ask us if you have any
questions pertaining to our policy.
Insurance
Plans
We are contracted with most major insurance carriers,
including Medicare. It is ultimately your (the
patient’s) responsibility to confirm that we are
participating providers for your insurance plan. Please
call the customer service phone number on your insurance
card to verify coverage or visit your insurance
company’s website.
Insurance
Terminology Definitions
Every individual’s insurance plan benefits are unique.
Most insurance plans are calendar year plans, meaning
the benefit period renews each year on January 1st. For
example, any amount paid the insurance company in 2010
will not apply to 2011 benefits. Other plans are
“Benefit Year” or “Plan Year”. In these cases, the plan
may renew July 1st and end on June 30th of the following
year. We recommend that you contact your insurance
company to verify which type of plan you have. Some
plans may be a Calendar Year Plan even if your coverage
did not begin in January.
Most insurance plans have a deductible. The
deductible is the amount, contracted with your insurance
company, that you must pay out of pocket before the
insurance will begin to cover any incurred expenses. As
stated above, all insurance plans are unique and
therefore the deductible may apply to office
consultations and/or any procedures that are performed.
If you have questions about how your deductible is
applied, please contact your insurance company’s Member
Services.
Some insurance plans require a copayment (co-pay)
for medical services. A co-pay is a unique contracted
fee for specific services. For example, you may have a
$25 co-pay for office visits to the primary care doctor
and a $50 co-pay for specialist services. (Boulder
Endocrinology is a Specialist Office).
Some insurance
plans also have co-insurance. The co-insurance is
the portion that the you pay once the deductible has
been met. It is a shared agreement between you and the
insurance company, and states that you will cover a set
percentage of the incurred expenses. For example, you
pay 30% of the balance due and the insurance company
pays the remaining 70%.
If a plan has a
co-insurance, it may also have an out of pocket
maximum. The out of pocket maximum is the amount
which the you must pay before the insurance will cover
100% of additional claims.
Please note that
Boulder Endocrinology estimates your portion of expenses
based on the information we receive from your insurance
company. This payment is expected at the time of your
visit. (We obtain this information either through a
phone call to the insurance company or from their
websites.) We are contracted with most insurance
companies therefore are able to use our contracted rates
to estimate your responsibility. Once the claim has been
processed (usually 30-60 days, as claims are submitted
electronically), we will provide a prompt refund for any
overpayment made. If you have questions about your
individual benefits, please contact your insurance
company’s Member Services.
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