Payment Policies and Information

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Payment Policies and Information

• Methods of Payment
• Medicare / Medicaid
• Managed Care - What is it?
• What does HMO, POS and PPO mean?
• Managed Care - Your Responsibility
• Functional Orthotics

 

Methods of Payment

• Cash
• Check
• VISA
• MasterCard
• Discover

 

Payment is expected at the time of service unless other arrangements have been made with the office. We accept cash, check, Visa MasterCard, and Discover. Please see our Financial Policy Agreement for further information.

Medicare / Medicaid

Medicare / Medicaid. The office participates with both Medicare and non-HMO Medicaid. Our staff will gladly submit your insurance claim. You are responsible for any deductible or non covered services. Medicare will not routinely pay for cutting nails and callus. This service may be covered if you have advanced vascular disease and or Insulin Dependent Diabetes.

Medigap. Due to staff limitations and cost containment, we are unable to submit claims to Medigap or other secondary insurance plans. Medicare may automatically roll over to certain Medigap insurances, requiring no action on your part. However if this is not the case, you will be responsible for your portion of the deductible or co-pay.
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Managed Care - What is it?
In response to the escalating cost of health care, Insurance plans have entered into contractual arrangements with doctors to provide medical services for a discount rate. The number of doctors who participate with each plan is limited.
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What does HMO, POS and PPO mean?

Health Maintenance Organizations. Some plans further limit costs by restricting patient access to specialists. To see a specialist in such a plan the patient must first visit his or her Primary Care Doctor or “Gate Keeper”. If the Primary Care provider deems necessary, a “referral” is made to the specialist physician. This type of Plan is typically called an HMO (Health Maintenance Organization). If you have an HMO plan, you can not be treated in our office without a valid referral and/or referral number, even if you are an established patient.

Point of Service Plans. If your Insurance plan allows you to go to a specialist either with or without a referral, you may have a POS (Point of Service) plan. This plan is a hybrid between an HMO and PPO plan. Technically it has the same restrictions with regard to tests and professional services as an HMO. If you choose to see a participating specialist without a referral you may incur a higher out of pocket expense.

Preferred Provider Organizations. A PPO allows you to see a specialist without a referral. However, the specialist must be selected from a list provided by your insurance company. Such plans allow greater freedom for the patient to choose a doctor and for the specialist to take tests and provide necessary procedures. Usually PPO’s will cover a wider array of medical services, including functional orthotics.
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Managed Care - Your Responsibility
Each time you are seen in the office you will be asked to make a small payment or co-pay. The co-pay, usually between five and twenty dollars, is part of the discount reimbursement your doctor receives for his services. Co-payments also help keep the cost of your insurance premium down, by cost shifting some of the financial responsibility to those individuals who utilize professional medical services.
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Functional Orthotics
Functional orthotics are custom-made arch supports. Orthotics are produced from a plaster mold of your feet. The foot is held in "neutral position" during the casting process. This position allows the orthotic to control excessive pronation while providing physiologic motion for proper shock absorption by your feet. After casting, the molds are sent to an outside laboratory to be manufactured. This process can take 3 to 4 weeks.

Our fee is $550.00 for one pair of orthotics. The orthotic fee includes casting supplies, outside laboratory fees and one follow up office visit for needed adjustments in the month after dispensing the orthotics.

If your insurance does not cover orthotics, you will be required to make a deposit of half the orthotic fee at the time of casting, with the balance due upon dispensing the device in 1 month.

A $100.00 discount is available for a second pair of orthotics, should a special type be needed for dress shoes, etc. The second pair must be ordered in the first six months after you receive your orthotics. After six months, the lab will discard your molds and the casting process must begin again.
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