General:
If you are a member of an insurance plan, you have entered into a legal and contractual agreement between you and your insurance company regarding the terms of your coverage.
J. Gabriel Guajardo M.D., P.A. is pleased to be a preferred in-network provider with most major insurance companies. This means that we, too, are contractually obligated to abide by the terms of your agreement and ours. As a courtesy to our patients J. Gabriel Guajardo M.D. will contact your insurance carrier to help you determine your deductibles, co-insurance payments, and co-pays. Both patient and provider are legally obligated as members of an insurance plan to abide by terms of that plan.
Financial Obligation:
It is our preferred office policy to collect payment at the time services are rendered. This includes co-payments, deductibles, co-insurances and any non-covered services as stated in your financial contract with your insurance carrier. We accept cash, checks, and credit cards. We will file insurance claims on your behalf as a courtesy, however if we are unable to verify your benefits prior to your appointment you will be responsible for the charges incurred. Accounts that become delinquent after 90 days will be referred to an outside agency and are subject to additional fees. There is a 25.00 fee for returned checks.
Our Practice Is In-Network :
Blue Cross Blue Shield (BCBS), United Healthcare (UHC), Valley Baptist Health Plans, Aetna, Tricare Prime, Don’t see your plan listed? Please contact our office as we are in network with additional plans not listed.
Deductible:
The deductible is a specific fixed dollar amount that your insurance company requires you to pay on claims before the insurance company will pay for covered services. Deductibles vary from $0.00 to $5,000.00 or even higher. The deductible is an annual amount per insurance calendar year. This does not always correlate with a January calendar year.
Co-insurance:
A co-insurance is the percentage of medical charges that your insurance company requires you to pay after you have met your deductible. The more common co-insurance amounts are 80/20, in which you are required to pay 20% of the allowable medical charge, and 90/10, in which you are required to pay 10% of the allowable medical charge.
Co-pay:
A copay is the flat amount your insurance company requires you to pay at the time of medical services or to receive a medial prescription. Each insurance plan establishes these fees upfront..
Obstetrical Fees:
The fees for Obstetrical Care include medical care from your first visit after confirmed through your prenatal care, delivery and post partum care. This is called Global Fee. Full payment is due by your 36 week of pregnancy.
* Lab work, ultrasounds, hospital visits, and visits not related to your pregnancy are NOT part of the global fee and are billed separately.
Global Fee is a term used to describe how most insurance companies require that we bill for your maternity care. This global fee includes all of your routine prenatal visits: delivery and the post partum follow up visit. You will meet with your Ob Coordinator at the beginning of your pregnancy that will expain in detail your financial obligations and answer any financial questions or concerns you may have.
Surgical Fees:
The surgical fee includes the procedure performed by your physician you may incur other fees if any assistant surgeon is required.
Your financial portion is due in full before the surgery is performed.
Your Surgery scheduler will contact you directly and speak with you regarding your scheduling and financial information.
Insurance and Billing
As a service to our patients, we bill insurance companies for our office visits and affiliated hospital charges. If we are unable to verify your insurance, you will be expected to pay cash or credit card for services rendered that day. You will be provided an itemized receipt so you can in turn file a claim for reimbursement from your insurance provider. All co-payments are requested at check in and can not be waived due to our contractual agreement with insurance providers. Patients are responsible for paying co-payments, deductibles, co-insurance and charges denied by your insurance company at each visit. It is the responsibility of each patient to "KNOW" their benefits and what services are included in their plans and which ones are not.
Please call the office to verify if we are in-network with your insurance.
Thank you,
Management
