Insurance & Payment Policies

 

DEPOSIT 

See General Policies for Initial Appointment Deposit Payment policy.

 

GENERAL IN-NETWORK INSURANCE  

The contract with an insurance company to pay for any portion of patient medical care is between the patient and the patient insurance company. NeuroScience & TMS Treatment Centers (NS-TMS) clinicians are in-network with SOME insurance and NS-TMS files Patient’s claims for in-network insurance only. If the Patient provides accurate insurance information and is properly covered, NS-TMS will file in-network claims and follow up on reimbursement. If we are in-network with an insurance company and are contractually required to obtain authorization for care, we will complete this process. 

 

A patient must certify that he/she (or Patient’s dependent) has insurance coverage, and If any NS-TMS clinician seen is a contracted provider with the Patient’s insurance, the Patient assigns directly to NS-TMS all insurance benefits. NS-TMS will file these in-network insurance claims and it is the Patient obligation to pay the copay, deductible, and any co-insurance due. If the Patient’s insurance company fails to reimburse because of non-coverage, the Patient is still financially responsible for all charges. The Patient, hereby, authorizes NS-TMS to release all information necessary to secure the payment of benefits. The Patient authorizes the use of this signature on all insurance submissions.

 

OUT OF NETWORK INSURANCE  

Payment is due at the time of service, regardless of expectations that out-of-network insurance will cover claims. By reducing costs associated with billing, coding diagnosis and procedures, referrals, authorizations, payment delays, EOB reviews, claim denials, resubmissions, collection risks and other managed care costs, we can focus on Patient’s care. Reimbursement, if allowed, will be paid to the patient as is allowed by your insurance. If you are out-of-network, you will be expected to pay in full for your appointments and services rendered in the clinic. NS-TMS cannot and does not guarantee out-of-network insurance reimbursement of any kind. We can provide a statement of service (SOS) to the patient or parent/guardian for reimbursement out-of-network, but you will have to submit this form to your insurance company. We recommend that Patients contact their insurance carrier and request instructions for filing claims. Patients must follow up with their insurance to understand how claims will be reimbursed. The Patient or responsible party is responsible to check with their insurance plan from time to time to ensure claims are being properly processed. 

 

OUT-OF-NETWORK AUTHORIZATIONS

Upon Patient request, we will provide a list of fees and billing codes before any services are performed.  A current list of fees is attached and is subject to change. We recommend contacting the Patient’s insurance carrier to verify benefits and to find out how much insurance will reimburse for services provided by our office. It is the Patient’s responsibility to obtain all referrals/authorizations required by the Patient’s out-of-network insurance plan to file claims. 

 

NON-COVERED SERVICES/CHARGES 

The Patient has been informed that the Patient’s healthcare benefits insurer or the administrator of the benefits for the insurance plan may determine that some procedures and events are not covered by insurance, these are called NON-COVERED SERVICES. 

 

NON-COVERED SERVICES include but are not limited to: 

  1. missed appointments, (patient will be charged the full cost of the visit that is missed)
  2. appointments canceled with less than 72-hour notice, (patient will be charged the full cost of the visit that is canceled)
  3. prescription refills outside visits, (the patient will be charged $30 for the refill at the clinician’s discretion)
  4. phone calls outside scheduled visits, (the patient will be charged at a prorated hourly rate at the clinician’s discretion)
  5. emails to clinicians outside of scheduled visits, (the patient will be charged at a prorated hourly rate at the clinician’s discretion)
  6. visits via telephone or electronic means instead of in-office visits, (patient will be charged the full cost of the visit unless insurance allows telemedicine visits at the same rate as face to face visits)
  7. reviewing genetic testing, (the patient will be charged $50 for the review at the clinician’s discretion)
  8. laboratory collection fees, (the patient may be charged $30 to collect and process the specimen)
  9. emergent or urgent calls after office hours, (the charge is $100 per 10min at the clinician’s discretion)
  10. paperwork completed outside of office visits, e.g. records review, lab review & prior authorization paperwork (the patient will be charged based on the clinician’s time utilized at the clinician’s discretion)

 

Our clinic charges for these services as it takes valuable clinician time to complete the tasks or services. The Patient has been informed what the potential costs of the referenced service(s) will be if elected to receive the service(s). 

 

Patient understands that if insurance plan determines that the service(s) is not a Covered Service, an Investigational Service, is or the service is not considered to be Medically Necessary or Medically Appropriate, then Patient will be responsible to pay for all costs associated with the service(s), including, but not limited to, practitioner costs, facility costs, ancillary charges, and any other related expenses. The Patient acknowledges that his/her insurance plan may not pay for these service(s) or treatment(s) and the patient would be responsible for these non-covered charges. 

 

These services may be an Excluded service (non-covered service), may be designated Investigational Services, may not be considered Medically Necessary or Medically appropriate by insurance, or per a patient benefit plan from a specific Insurance Plan. A NON-COVERED service would be excluded from coverage by The Patient’s health care benefits plan. NS-TMS Clinicians strive for the best evidence-based medical care and cannot foresee how an insurance company may decide the medical necessity of service. If the treatment or service we prescribe as first-line care is not covered or available with your health plan; NS-TMS clinicians will inform patients about alternative treatments that may be covered by the Patient’s Insurance plan. We do strive for the best options and try to utilize a patient’s covered services first. 

 

The Patient understands that the Provider may request that the Patient’s insurance plan reconsider that determination by presenting further evidence that the referenced service(s) should be covered. For example, in times when an insurer claims that service is investigational, NS-TMS might present data to the insurance company that shows that the service or treatment is not an Investigational Service, is a Covered Service, or that the service is considered to be Medically Necessary or Medically Appropriate. The Patient also understands that the Patient has the right to request a reconsideration of that determination, as described in the Member grievance section of the health care benefits plan, either before or after receiving the service(s). 

 

PAYMENT OF NON-COVERED CHARGES 

The Patient understands and agrees that the Patient is 100% responsible to pay for the full charge for non-covered services, as published or a prorated amount of provider’s time (Physician’s time $350/hour, NP’s time $200/hour). The Patient approves and authorizes NS-TMS to charge the Patient’s credit card as these (non-covered service) payments become due.  The Patient is aware that the initial and follow-up appointments cancellation policy requires a notice three (3) business days prior to the appointment in order to avoid being charged for a scheduled service. 

 

FINANCING OPTIONS FOR PAYMENT  

We do not have payment plans or financing options internally. We recommend using a credit card to finance your payments with us if you prefer. 

 

GOVERNMENT SPONSORED INSURANCE (MEDICARE, MEDICAID, OR TENNCARE) 

The Providers at NS-TMS have chosen not to enroll OR have chosen to terminate their Medicare contracts. We are not Medicare, Medicaid, or TennCare Providers. All patients who have Medicare insurance policies (eligible for Medicare) must note that NS-TMS may not file a claim to Medicare, Medicaid, nor TennCare for reimbursement of your medical services. Government-Sponsored insurance plans may require and stipulate physicians, nurse practitioners, therapists, and other clinicians to practice with specific medication formularies, and specific treatment protocols. Our office does not work with these government-sponsored insurance plans. If you have these plans, you may receive care by clinicians who accept and work with your plan. It is important that you understand that these plans likely will not cover your care (visit costs) and may not cover your medications, or your diagnostic workup recommended by the clinician (tests and labs ordered). 

 

Medicare usually requires that Opted-out providers or Non-Medicare providers enter into a private contract with patients in compliance with 42 U.S.C. §1395a; 42 C.F.R. § 405, subpart D. As we are NOT Medicare providers, have not been excluded, and have not entered into a contract with Medicare, we will not ask you to enter into a private contract. We want our Medicare beneficiaries to know that you can individually file a claim with Medicare using form 1490 S which can be obtained via the company that manages your benefits (PALMETTO in TN). Again, we cannot file the claim for you, as we are not contracted with these companies. You may be reimbursed directly for the portion Medicare would have paid an in-network Medicare provider. 

 

INSUFFICIENT FUNDS

The Patient agrees and understands that the Not Sufficient Funds (NSF) Fee will be added to the Patient’s account for any “bounced” check. 

 

INTEREST PENALTY ON OUTSTANDING BALANCE  

The Patient agrees and understands that any outstanding balance over 60 days is subject to the highest interest rate allowed by law in the State of Tennessee.

 

OUTSTANDING BALANCE PAYMENT GUARANTEE 

While the majority of patient fees are paid for at the time of service, some charges like emergency calls, prescription refills outside an appointment, no show charges, record reviews, letters, consultations with outside providers, bounced checks, etc., as an example, may incur when the patient is not available to pay. In the event the patient incurs any charge at any time, the Patient hereby authorizes this office to charge the credit card on file for the total amount outstanding. The Patient can request that another form of payment be used for these outstanding charges. Upon request, the Patient can be given a completed statement of service with all the codes necessary to file a claim with your insurance carrier. We recommend you contact your insurance carrier and request instructions for filing your claims. You may request a statement from billing by faxing our office or contacting our billing office.