BILLING AND INSURANCE

Financial Policy

Traditional Indemnity Insurance and Self-Pay: We encourage payment for services rendered at the time of your visit. We accept payment by cash, check, VISA, Master-Card, Discover, and American Express. We will gladly submit your claim to your insurance company. Since your insurance policy is a contract between you and your insurance carrier, we do not guarantee payment of your claim, nor assume responsibility of meeting requirements for pre-authorizations, second opinions, and hospital stays. We will, of course, be happy to furnish you with any documentation you may need to resolve any disputed claims.

Managed Care (PPO and POS plans): Payment of any applicable deductibles and co-pays should be made at the time of your visit. We will submit a claim to your insurance carrier for direct payment to the Clinic. We make every effort to be aware of obligations under your plan for pre-authorization, referral authorizations and other utilization management obligations in order to be able to provide the services you need based on your health status. Your awareness of your plan's requirements will add a greater level of assurance that these obligations will be met, which, in the long run will benefit you. It is important for you to know that your insurance may not pay for all services provided at the Clinic depending on your specific employer plan benefits. You will be responsible for all services that are considered non-covered, experimental, or procedures deemed not medically necessary by your insurance company.

Questions regarding your account: Billing representatives are available from 9:00 a.m. to 7:00 p.m., Monday through Friday, to answer any questions you may have regarding your account status. You may call (713) 520-4700 to speak to a billing representative.

Medicare

What is Medicare?
Medicare is a health insurance program administered by the U.S. government for people 65 or older and for some disabled persons under 65. It is divided into two parts: hospital insurance (Part A) and medical insurance (Part B). We bill Part B insurance when services are rendered at the Clinic or by a Clinic physician.

At Medical Clinic of Houston, L.L.P., we gladly complete and submit all Medicare claims on your behalf. The physicians at MCH have chosen to be in the participating category of physicians in the Medicare program, which means your MCH physician will accept Medicare assignment.

It is important for you to know that Medicare does not pay for all services provided at the Clinic. Medicare may determine your diagnosis doesn't qualify for coverage for certain procedures (limited coverage procedures) or that you have had these tests too recently. If you have one of these procedures performed, you will be asked to sign a waiver stating that you will be responsible for payment should Medicare deny payment.

Medicare also does not pay for "non-covered" services, which are services that fall outside of the Medicare program. Physicians, whether "participating" or "non-participating," can bill their usual patient fee for any non-covered services, and beneficiaries are responsible for full payment of those services.

Medicare Replacement Plans

At this time, Medical Clinic of Houston, L.L.P., is currently only accepting the Medicare Private Fee-For-Service (PFFS) plans through Secure Horizon and Humana. The Clinic does not participate in any Medicare HMO or PPO plans, and these plans do not provide out–of-network benefits.

How Can I Claim Benefits?

The Clinic will complete and submit claim forms to your Medicare carrier and secondary carrier(s) for services rendered at the Clinic or by a Clinic physician. The Clinic is directly reimbursed for 80% of Medicare's allowed amount minus any unmet deductible. A claim will be filed with your secondary insurance company, if any, after Medicare pays. You will be responsible for the remaining balance (the "co-insurance"), plus any part of the deductible you may owe. All clinical laboratory services are reimbursed at 100% of the amount approved for each test. For clinical laboratory services only, no deductible or co-insurance is required of you.

Collection Policy for High Dollar Procedures

Patients scheduled for certain procedures including CT Scans, MRIs, Nuclear Cardiology Studies, and Echocardiograms will be responsible for making payment arrangements for the self-pay portion prior to the test being performed. This includes the amount owed due to the patient's annual deductible, coinsurance, non-covered services, usual and customary reductions, or lack of medical coverage.

Heart Scans

Patients are required to pay for heart scans at the time of service.