Youngstown Orthopaedic Assoc. Ltd. Group staff is committed to providing quality medical care and efficient patient services to our patients. This financial policy is an outline of your financial responsibilities to your physicians and the group. Without your participation in this policy, it is not effective.
Because of the continuing changes from insurance companies, it has become necessary for us to register you every year to keep your information accurate and up to date. It is your responsibility to advise the staff of any changes in your insurance coverage, your address or your employer.
OUR CHARGES: Billings to insurance companies requires each procedure to be coded with a diagnosis code (ICD) and a procedure code (CPT). The American Medical Association along with HCFA set up these codes in a manual. FRACTURE CODES are coded under a surgical section in this manual. If you have a fracture and/or surgery, the charge for these procedures is a flat fee followed by a global period that is determined by your insurance company. If a cast is applied, the first cast is included in the fracture charge. For additional casting, there will be a casting charge. There will be charges for any x-rays taken during the global period for the injury treated.
PAYMENT IS DUE AT THE TIME OF SERVICE IF YOU HAVE NO MEDICAL INSURANCE. You will be expected to pay a pre-arranged amount of $225 (consultation & x-rays) prior to service with the balance for treatment (i.e. fracture care) being paid in 30 days. For fractures requiring surgery or elective surgeries, one half of the anticipated cost is required prior to the procedure with balances due in 60 days. If needed, our billing staff will work with you to make payment arrangements as well as offering a Care Credit Option.
CO-PAYS, CO-INSURANCE AND DEDUCTIBLES must be paid at the time of service. Our staff will verify your benefits with your insurance carrier. If we participate with that insurance, an allowance will be made for the adjustment amount. Office visit co-pays are to be paid at the time of service and are not a billable charge to your insurance company. Failure to pay your co-pay will be reported to your insurance carrier. The co-pay is your contract with your insurance carrier and we are required to collect that amount at the time of service.
PARTICIPATING INSURANCE CARRIERS ARE EXPECTED TO SEND YOA PAYMENT IN 30-45 DAYS. Unfortunately, this does not always happen. If you have been to your physician and haven’t received an explanation showing your physician’s payment, please call your insurance company and inquire about your physician’s bill.
STATEMENTS are sent out monthly for patients with personal balances. Payment is due upon receipt of the statement. If you are not able to pay the balance in full, please contact the billing department.
If you pay for services and then your insurance pays for those services creating a credit on your account, your personal credit may be moved to pay another personal balance. If you have a credit on your account, you may use that credit to pay a co-pay or deductible on future visits. Insurance credits or overpayments must be refunded to your insurance carrier. Refunds will be issued after all visits have been billed and paid by your insurance company and after final treatment.
PERSONAL BALANCES OVER 90 DAYS FROM THE DATE OF SERVICE will be sent to our collection agency. Statements will be sent every month; if there is no response to our final notice, then our collection process will begin. We will attempt to reach you by phone or in writing. If our attempts are unsuccessful then your account will be sent to our Collection Agency. Our collection agency will make several attempts for payment in full on these balances. They will give you another 30 days to pay this bill before reporting it to the Credit Bureau, which will result in a mark on your credit report.
NON-SUFFICIENT FUND CHECK – If a NSF check is returned to YOA, a $35.00 fee will be added to your account balance in addition to the amount of the check written. A letter will be sent to you requesting the check amount and the fee be paid in cash within 14 days. If the amount is not made good within 14 days, the account will be turned over to the collection agency. On future visits, you will be required to pay cash in advance for the visit, and for any open balances that are with the collection agency or us until you can re-establish a good credit rating with the group.
MINORS – A parent or legal guardian bringing the minor for treatment and making financial arrangements should accompany minor children. If children are brought into the office for treatment by a custodial parent, we can submit the charges to another parent’s insurance, however, the parent presenting the child for care will be billed for the balance not covered by the insurance.
MED PAY – In the event of a motor vehicle accident, sources of medical bill coverage, such as MedPay or other than health insurance, may be billed before health insurance for payment. I waive any protection from R.C.1751.60 . I request that Youngstown Orthopaedic Assoc. LTD bill my auto medical payment coverage before billing my health insurance.
FURTHER, I understand that I am entering into a contractual relationship with Youngstown Orthopaedic Associates, LTD. and/or physician herein referred as YOA for professional care. I further understand that merit less and frivolous claims for medical malpractice have an adverse effect upon the cost and availability of medical care and may result in irreparable harm to a medical provider. As additional consideration for professional care provided to me by YOA, I, and/or my representative agree not to advance, directly or indirectly, any false, merit less and/or frivolous claim(s) of medical malpractice against YOA and/or physician.
Furthermore, should a meritorious medical malpractice case or cause of action be initiated or pursued, I (patient) and/or my representative agree to use ABMS board-certified expert medical witness(es) in the same or similar specialty as physician. I agree that these expert witnesses will adhere(s) to the guidelines and/or code of conduct defined by the specialty society(ies) for expert witnesses in the area(s) of medicine that would typically have the background and experience to opine on such a case. In further consideration for this YOA, agree to the same stipulations.
APPOINTMENTS – CANCELLATIONS MUST BE MADE 24 HOURS IN ADVANCE OF THE SCHEDULED APPOINTMENT OR YOUNGSTOWN ORTHOPAEDIC ASSOCIATES RESERVES THE RIGHT TO ASSESS A FEE.