As you may know, there are very specific regulations about billing for health care services. As your health care provider, we are obligated to follow those regulations in how we report services provided to you. Additionally, every insurance plan may have different rules that vary from insurer to insurer and may even vary between plans of the same insurer.
- All physicians/providers must report services using a variety of codes to tell the insurance company what was done and why.
- It is not uncommon for patients in the course of a visit to receive management and treatment services for a separate and specific problem, as well as routine or preventive services at the same visit.
- Both services must be reported to the insurance company and may result in an additional co-payment or charge as per the insurer’s plan rules, which we are obligated to follow.
- There are many different insurance companies and plans; addressing a problem may trigger a co-payment or additional charges to your account.
- Your financial responsibility is determined by the rules of your insurance company, which we are obligated to follow.
- If you have questions, please check with your insurance plan.
We are dedicated to providing the best possible care for you and your family and to being respectful of your time.
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This sample document was adapted from an original document created by St. Cloud Medical Group, PA. It is provided only as a reference for practices developing their own materials and may be adapted to local needs. This document does not represent official American Academy of Pediatrics (AAP) policy or guidelines and the AAP is not responsible for its use. You should consult an attorney who is knowledgeable about the laws of the jurisdiction in which you practice before creating or using any legal documents.
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. This content is for informational purposes only. It is not intended to constitute financial or legal advice. A financial advisor or attorney should be consulted if financial or legal advice is desired.