What to Know About Using a Third-party Payer

You should be aware of the following if you are using a third-party payer to pay your charges:

  • You must add your newborn to your policy. No one else will or can do this for you. Delays in enrolling your newborn may result in out-of-pocket costs to you.
  • You are solely responsible for providing us with your policy information at the time of service, and for ensuring your policy information remains current.
  • Your policy is a contract between you and your third-party payer.
  • You are solely responsible for fully understanding what your policy will or will not cover. Our courses of treatment, prescriptions and referrals are guided by what is in the best interest of the patient’s care; we do not tailor our services to the whims of a third-party payer. You—as an informed consumer—are solely responsible for accepting or refusing services, prescriptions or referrals based the specifics of your policy’s coverage.
  • As a courtesy to you, we will file a claim once with your payer using the policy information you provided. Incorrect or incomplete information may result in delays or claim denials that result in out-of-pocket costs to you. We are not obligated to re-file a claim due to your failure to provide correct policy information.
  • Any dispute with your payer over what should or should not be covered is a dispute between you and your payer. We will hold you financially responsible for all charges deemed “patient responsibility” by your payer, regardless of any dispute.
  • All information provided by your payer regarding the potential of your policy to cover a future claim for services rendered is pure speculation. Therefore, neither we nor you have any guarantee that your payer will pay a claim until the actual claim is filed and processed, regardless of anything the payer said beforehand.
  • Third-party payers reserve the right to alter or reverse a prior claim payment—at any point in the future—should they receive or uncover information that results in a different payment amount or in a claim denial. Therefore, we will bill you—at any point in the future—for any balance due that results from your payer altering or reversing a prior payment.
  • If you are using a policy obtained via an Affordable Care Act (ACA) exchange, and you are in month 2 or 3 of the “Three-month Grace Period” for premium non-payment, we will not accept your policy as payment for services rendered. Your policy will not be accepted until your third-party payer confirms that your policy is again in good standing. If you wish to receive services in our clinic during this period, you may do so as a self-pay patient.