Billing and Insurance
For insurance and or billing questions not answered below or questions regarding your account, you may contact our Customer Service Call Center @ 713-520-4700. Billing representatives are available to assist you Monday through Friday from 9:00 am – 4:30 pm.
As a courtesy to you, the Clinic will verify your health insurance coverage and benefits as well as file a claim with your insurance carrier once medical services have been rendered. To assist us with this service, please contact our registration representatives at least 24 hours in advance of your appointment (if you haven’t done so already) at 713-526-5511, x 4624, to provide us with your health insurance plan information.
We encourage payment for services rendered at the time of your visit, including payment of applicable deductibles and co-pays. We accept payment by cash, check, VISA, Master-Card, Discover, and American Express.
Traditional Indemnity Insurance and Self-Pay: Since your insurance policy is a contract between you and your insurance carrier, we do not guarantee payment of your claim, nor do we assume responsibility for meeting your insurance plans’ requirements for pre-authorizations, second opinions, or hospital stays. We will, of course, be happy to furnish you with any documentation needed to obtain necessary approvals or to resolve a disputed claim.
PPO and POS plans: Payment of 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 of your insurance benefits. 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 your plan’s obligations will be met which, in the long run, will benefit you. It is important for you to know that your insurance plan may not pay for all services provided at the Clinic. What is covered is dependent on your plan’s benefits. You will be responsible for all services rendered that are considered non-covered, experimental, or deemed by your insurance company as not medically necessary.
HMO and gated plans : If your health plan requires you to select a primary care provider (“PCP“) please contact your Plan Administrator to designate your MCH general internal medicine physician as your PCP at least 24 hours in advance of your visit.
Medicare: Original (often called traditional) Medicare is a health insurance program administered by the U.S. government for people age 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.
MCH physicians have chosen to be in the participating category of physicians in the Original 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 does not qualify for coverage for certain procedures (e.g., limited coverage procedures) or that you have had a test too recently. You may be asked to sign a waiver [i.e., a Medicare Advanced Beneficiary Notice (“ABN”)] 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 fee for non-covered services. You will be responsible for full payment of non-covered services.
Medicare Replacement Plans: Medicare also offers Medicare Advantage plans through various for-profit insurance companies. The ONLY Medicare Advantage plan patients our physicians will accept will be those patients covered by the Aetna Teachers’ Retirement Medicare Advantage plan (TRS.MA), effective January 1,2013.
Please be aware that the Clinic does NOT participate in Medicare Advantage (HMO or PPO) plans or accept Medicare Advantage patients. As an exception to this policy, the Clinic has agreed in principle to see Aetna Teachers’ Retirement Medicare Advantage patients on an out-of-network basis.
How Can I Claim Benefits? The Clinic will complete and submit medical claim forms to Medicare and one secondary carrier for services rendered at the Clinic or by a Clinic physician. Generally, the Clinic is directly reimbursed for 80% of Medicare's allowed amount minus your 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, as long as the tests are deemed by Medicare to be medically necessary and provided within required timeframes.
Payment for specialized procedures
Advanced procedures: Patients scheduled for certain procedures including, but not limited to, CT Scans, MRIs, Nuclear Cardiology Studies, Echocardiograms, and Sleep Disorder Studies will be responsible for making payment arrangements for the self-pay portion of the study prior to the test being performed. This includes the estimated amount that will be owed due to your annual deductible, coinsurance, non-covered services, frequency limitations, or lack of medical coverage
Cardiac Score Scans: Patients are required to pay for Cardiac Score (heart) scans at the time of service.