- This facility is not contracted with any insurance company or self-funded plan. Patients would be using their out-of-network benefits. Please check with your insurance carrier or plan administrator so that you are fully aware of your policy provisions and your insurance plan allowance (benefit coverage).
- Based on the information that you have provided us, your insurance coverage will be verified prior to the date of your procedure. A patient account representative will contact your insurance carrier to determine co-pay and co-insurance or deductible liability, verify approval for medical necessity, and confirm a valid referral is on file. The information provided to us does not guarantee coverage or payment from your insurance carrier. Note that failure to pay the applicable deductible and cop-pay may affect your contractual obligations with your insurer, and thus your continuation of coverage. While IMC Pain Free may agree to await the explanation of benefits from your carrier to determine your responsibility for payment under your plan, payment in full is expected once a determination of your responsibility under your plan is determined.
- Additional charges may be incurred separate from Osteopathic Treatment and Diagnostic Services. There may also be fees associated with laboratory specimens, radiology services, or emergency costs.
- Even though you have assigned your insurance benefits to Osteopathic Treatment and Diagnostic Services, there are times when an insurance company may forward Osteopathic Treatment and Diagnostic Services reimbursement directly to the patient. We request that you forward this payment and a copy of your “explanation of benefits” to the surgery center upon receipt.
- Patients are responsible for all amounts not covered by their insurance.
- In the event that an insurance appeal is necessary, IMC Pain Free will ask for your help with contacting your insurance company. While you are responsible for payment and appeal, we will do all that we can to insure maximum reimbursement for your procedure.
Patients without Insurance:
- If you are not covered by insurance, we ask that you speak with a patient account representative prior to your appointment date to discuss financial obligations.
Past Due Accounts:
- In order to avoid any late fees, finance charges, or collection and attorney expenses all accounts must be in good standing.
- State and federal law requires the Osteopathic Treatment and Diagnostic Service to verify and protect your medical identity. We take many precautions to protect your records.
- Our admissions staff require from the patient proof of his or her identity. You will need to bring a current photo identification, your insurance card(s), and the name, address, and telephone number of your employer.
If You have Questions:
- Insurance requirements are complex and can be confusing. We will do all that we can to maximize your benefits and reimbursement. While payment of fees is your responsibility, we will assist you with your insurance claim. Please do not hesitate to speak with our patient account representative if you have questions.