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Billing / Insurance

Billing & Insurance

Notice to our patients:
Effective January 1, 2008, please give 24-hours notice of cancellation to avoid a $55 No-Show Charge.

Contents

Your Billing Questions
Insurance Participation
How To Pay
Payment Plans
Patient Statements
Form Completions
Copying Charges
Late Charges
Understanding Your Insurance
Medicare Prescription Card link

Your Billing Questions

Our Billing & Insurance staff is always happy to help you understand your bill and to assist you in obtaining insurance payment. Simply call 814-234-3813, or drop by our State College office. Please be prepared with your account number found on your billing statement.

Questions regarding your insurance coverage are more appropriately directed to your employer or insurance company.

Insurance Participation

We participate with the following insurance plans:

• Advantra
• Capital BlueCross/Keystone Health Plan Central/Senior Blue
• CHAMPUS/Tricare (not managed care plans)
• Clear Care Corporation
• Devon Health Services Inc.
• Federal Black Lung Program
• Geisinger Health Plan, Geisinger Gold
• HealthAmerica, Penn State Choice, HealthAssurance
• Highmark Blue Shield, Premier Blue Network
• Medical Assistance / Access Plus
• Medicare
• The Preferred Healthcare System, Inc.
• Railroad Medicare
• United Mine Workers

If we participate with your insurance plan, we will submit insurance claims for all office and hospital services. You are responsible for:

• copayments at the time of service
• deductibles
• non-covered services

If we do not participate with your insurance plan, full payment is requested at the time of service for physician charges. As a courtesy, we will submit a claim to your insurance for all other charges incurred, however you are responsible for paying all charges within 30 days of service regardless of what your insurance covers.

Non-insured patients are responsible for all charges at the time of service.

Payment Plans

If you have accumulated a balance of over $500 which is not covered by insurance, and you are unable to pay the total within 30 days of service, you may be able to arrange installment payments. Contact our billing & insurance department at (814) 234-3813 to arrange a payment plan.

How to Pay

You may pay your bill by mail, phone or in person. We accept cash, personal check, Visa, Mastercard, Discover, or debit card.

Patient Statements

Your charges for all CMSA departments are included in a single monthly statement. Although your insurance company may cover the charges, you will continue to receive statements to inform you of the status of your account until all charges have been paid.

Form Completions

When you ask us to fill out a medical form, you will be charged a fee based on its complexity (length, number of questions, physician time). However, if the form is the reason for your visit, e.g. a driver license physical, you will not be charged for the form completion.

Copying Charges

Generally, when you ask us to transfer your medical records, you will incur a copying fee based on the number of pages. These fees are compliant with Pennsylvania law 34 Pa.B. 6474. When you request a copy of a lab report during an appointment, there is a $1 per page fee.

Late Charges

A $20 late charge will be assessed for personal account balances after 60 days and every 30 days thereafter. We encourage you to use your credit card rather than incurring late fees.

Understanding Your Insurance

It is very important for you to be aware of the requirements of your health insurance policy so that you will save out-of-pocket expenses and frustration later. Our staff tries to be helpful, but we cannot know everything about the hundreds of insurance plans available to our patients. If you have questions about your benefits, call your insurance company’s member services department (listed on the back of your insurance card) or your employer’s human resources department.

Managed care plans, in particular, have many rules that you and your physician must follow. For example, you will most likely need a referral or authorization from your primary care physician (PCP) before you see a specialist or have testing done. Failure to do so could leave you responsible for charges. In most cases, the insurance company will not allow your PCP to authorize the visit retroactively.

Even though CMSA has primary care physicians, specialists, and testing facilities, your insurance plan may still require referrals between our providers. In fact, you may have to go elsewhere for laboratory tests and x-rays depending on insurance plan.

When your physician gives you a written order for testing or refers you to a specialist, do not assume that these services have been cleared through your insurance plan. Your physician may not be aware of your insurance requirements. It is your responsibility to obtain any referrals that may be required. When you are given a written referral, remember to take it along to your appointment; otherwise the referral provider is not authorized to see you. Without a referral, you may have to reschedule the appointment or sign a financial waiver accepting responsibility for any charges.

You should also be aware of any drug formulary that your insurance plan utilizes and ask your physician about possible alternatives if your medication is not preferred or covered.