Our office is committed to providing quality and cost-effective healthcare to our patients. In today’s insurance environment it is essential that you understand which services and procedures are covered by your insurance plan and obtain any necessary authorizations or referrals prior to your appointment with us. It is your responsibility to understand the limits and restrictions affecting coverage for services provided by our specialty. Please review the following information in order to better understand our policies regarding payment for services.
Insurance reimbursement is a contract between you and your insurance company. As a courtesy to you we will file all primary and secondary claims for you. We require a current copy of your insurance card in order to do this and will need to be informed of any change in insurance status. You will be responsible for all co-pays, deductibles, and co-insurance amounts not covered by a secondary insurance policy along with the entire amount of any non-covered service. We are contracted with the following insurance carriers and are required to collect your co-payment at the time of service:
- First Choice
- First Health
- Healthy Options/CHPW/Molina/United Healthcare Community Plan
- Medicaid/ Washington Apple Health
- Premera Blue Cross
- Regence Blue Shield
- United Healthcare
We appreciate payment for services at the time they are rendered. For your convenience, we accept cash, personal checks, Visa, Discover, and MasterCard. We also realize that healthcare is sometimes an unplanned event, so we will attempt to accommodate your personal needs as circumstances require. In order to best meet your needs, please call our business office at 425-454-6674 with any questions you may have regarding our financial policy.
All women age 18 or older need annual gynecologic examinations, including a pelvic examination, as do sexually active adolescents younger than age 18. The well-woman visit is a key part of preventive care; it includes a discussion of the patient’s health history and reproductive health care needs, a physical examination, including a weight and blood pressure check, a clinical breast examination, and various tests depending on a woman’s age and risk factors for disease. Most insurance plans now provide 100% coverage for preventive services. Keep in mind there may be lab tests ordered that do not fall within the preventative guidelines of your insurance plan. It is important that you know which lab tests are allowed with a preventative exam.
Most insurance plans now offer 100% benefits for IUD and other contraceptive devices. The the insertion of IUD or Implantable Contraceptive device may require the use of anesthesia, or paracervical block and often an ultrasound is done immediately after placement to check the position. These services may not be covered at the 100% benefit level or may be subject to annual deductible and therefore not paid at 100% even though the IUD or Implantable Device is.
Women with Medicare
Our office is a participating provider with Medicare because we feel a moral and civic duty to provide services to this population of patients; many offices choose not to see Medicare patients. Medicare never covers a well woman exam and requires us to inform the patient by use of an Advanced Beneficiary Notice of Noncoverage (ABN) for this or any other service we know or have reason to believe will not be covered. The Federal Government has very specific requirements and guidelines for how we submit claims for these services. Medicare will pay for a Pap test, pelvic exam, and clinical breast exam every 24 months and for some women at high risk every 12 months. Because Medicare does not pay for this exam we “carve out” the charge for the Pap smear, pelvic exam and breast check from our fee for the appropriate preventative examination with the balance being due from the patient for the portion not covered by Medicare. We are required by law to bill this balance to the patient and are not allowed to write off the balance unless we receive proper proof of financial hardship.
Patients who do not have insurance coverage (or proof of coverage) or who choose to pay for non-covered services are expected to pay in full at the time of service. If you cannot pay the full amount then you must make satisfactory payment arrangements with our business office prior to receiving services.
OB Benefits and Billing Policies
Our obstetrical fee covers the services included in a standard vaginal delivery or cesarean section. Additional services may be required and billed during your pregnancy and delivery. In addition to the obstetrician’s bill, you may receive bills from the laboratory, hospital, anesthesiologist, radiologist and pediatrician. As a courtesy to you, we will contact your insurance company to obtain an estimate on your benefits. Remember that this is an estimate only, based on proposed services and information supplied by your insurance carrier. Please notify our business office immediately if your insurance changes during your pregnancy. The estimated patient balance is due in full by your 28th week of pregnancy. If you do not have insurance we require half of the fee for total care at your initial visit and the balance prior to delivery. You will be asked to speak with our business office when scheduling.
Thank you for your deposit. If you provide insurance information we will be glad to refund your deposit once we verify coverage and benefits for these services.
Our business office looks forward to assisting you in any way possible; you may contact us at 425-454-6674. Please notify us immediately of any possible changes in your insurance status during your pregnancy.
Our physicians also perform newborn circumcision. Most insurance carriers provide benefits for this service with the exception of Washington State employees’ health plans and Washington State Medicaid. The state does not consider newborn circumcision medically necessary, therefore this procedure is not a covered benefit on DSHS/Healthy Options plans. We require this fee paid in full by delivery or we will not perform the circumcision. In the event that you have a change of plan or deliver a girl we will refund the fee in full as quickly as possible.
If you require surgery the surgical fee will cover the anticipated procedure and the related post operative period. We will need to schedule a pre-operative exam one to two weeks prior to the surgery which will be billed separately. All associated lab fees, any required testing and your hospital stay are billed separately by the provider of those services. As a courtesy to you we will contact your insurance company to obtain an estimate on your benefits. Remember that this is an estimate only, based on proposed services and information supplied by your insurance carrier. The estimated patient balance is due prior to your surgery unless you have already made arrangements with our business office. Please call them at 425-454-6674 with any questions you may have regarding our financial policy and procedures.