How does the office verify insurance eligibility and benefits?

We only verify insurance eligibility electronically. If your insurance does not provide this information electronically to us then we cannot verify your policy and we would recommend that you call your insurance prior to your visit to verify your eligibility and network status as well as your coverage benefits.  Please understand that your insurance company sometimes does not update it's rolls in a timely manner and may list our office in network when we really are not.  If we suspect that we are not in network with your insurance at any time and that includes up and during your appointment time we may notify you that you can either convert to self pay or wait until we have notification in writing from your insurance company's provider credentialing department that we are in network with your plan. 

We do not verify in and out of network labs, in and out of network provider status, lab/imaging fees and deductibles, pathology fees, services issued by other providers or companies nor pharmacy formularies. This information however is readily available to you on your insurance company’s website or by calling your membership benefits number.

 It is the patient’s responsibility to know and understand their coverage and benefits including whether or not we are an assigned provider in their network.  Your insurance plan will not guarantee the accuracy of their confirmation of coverage or benefits, that you are eligible, that your benefits are in force or that we are in your network even when we do have verification prior to services rendered which is why we inform patients that we cannot fully be informed in regards to coverage and benefits until after a claim has been fully adjudicated. 

Managed Care Insurance Plans/HMO: Typically an authorization is required for these members. If preauthorization of services is required these arrangements must be made by your Primary Care Provider prior to scheduling an appointment. It is the patient’s responsibility to make sure this authorization has been obtained and if it has not been obtained by PCP you as the patient agree to accept all financial responsibility for the balance.  It can take up to 48-72 hours to obtain an authorization number from your insurance company therefore we advise that you make sure that we have this information BEFORE you present for your appointment.  We do reserve the right to reschedule your appointment if we do not have an authorization from your insurance.  If we do provide services to you and you do not provide us with an authorization number and you have an HMO you agree to pay your balance in full (which would be the entire balance of your visit charges as your claim would likely be denied).  

We do typically pre­verify plan eligibility (i.e. is your policy active or not) for patients as a courtesy however please understand that different insurance companies only provide certain information on electronic verification therefore verification of eligibility does not guarantee benefits or payment—that is not determined until a claim is actually processed.