Financial Policies

Our Financial Policies

Concerns or Questions? Call our Business Office at (518) 434-1456, x3280.

Welcome to Certified Allergy & Asthma Consultants

Thank you for choosing Certified Allergy & Asthma Consultants (Certified Allergy) as your provider of allergy and asthma care. We are pleased to have you as a patient.  Certified Allergy is dedicated to providing quality, accessible and cost effective health care and we strive to make every visit a positive experience.  This document is designed to provide our patients with an explanation of our financial policies.  Should this information not address your specific situation or if you have questions or concerns about your account, we encourage you to speak with a member of our Business Office staff.

Within this policy, the word “patient” can mean the patient of the practice or, in the case of minor children, the patient’s parent or guardian.

Participation with Insurance Companies

We have contractual agreements with many insurance companies and also participate with Medicare and New York Medicaid. We will bill these organizations in accordance with the terms of our contracts.  Certified Allergy reserves the right to determine which insurance companies or programs we participate with on an annual basis.

Our Services and Insurance Plan Coverage

Insurance coverage for allergy and asthma testing and treatment varies by insurance company, and can vary by each individual insurance plan offered by insurance companies or employers. If you have questions regarding the extent to which your insurance company will cover our services, please contact your insurance company or our Business Office prior to your visit.  Common services provided by Certified Allergy can include an office visit, skin testing, pulmonary function testing, ingestion challenges and allergy immunotherapy.

Patients Without Insurance

For our uninsured patients, payment in full is due at the time of service, unless other payment arrangements have been made in advance with our Business Office.

General Insurance Policy

We will file claims with your insurance carrier provided we have your current insurance policy information available. We cannot guarantee that your insurance carrier will pay all or even part of your claim.  Your insurance policy is a contract between you and your insurance carrier.  Ultimately you, as the patient, are responsible for payment to Certified Allergy.  You should resolve disputed coverage issues directly with your insurer or employer.  It is your responsibility to know the details of your insurance contract and whether our physicians are network providers for your particular plan.

When your insurance company processes your claim they may provide you with an Explanation of Benefits (EOB). This EOB will explain the amount the insurance company has agreed to pay.  Most insurance companies agree to pay only a portion of the charges with the remaining balance being the responsibility of the patient.  Because of policy deductibles, co-insurance, co-payments and possibly non-covered services, you may have a balance due after your insurance company processes your claims.

Co-payments

Co-payments and deposits will be collected at the time of your visit. Please check with your insurance company regarding any specialist co-pay requirements.

Deductibles and Co-Insurance

Many insurance plans now include annual deductibles requiring patients and their families to pay for medical services up to a specified dollar amount before the insurance company will pay for any medical services.

Once the annual deductible has been met, patients may still be responsible for fixed co-payments or a percentage of costs (co-insurance). Deductible and co-insurance balances for our services will be determined by your insurance company when they process your claims. If you are not enrolled in our Credit Card on File program, we will send you a statement when the claims have been processed. Patients with unmet deductibles may be asked to pay a deposit at the time of their visit depending on the nature of the visit.

Forms of Payment Accepted

We accept cash, check, debit cards and all major credit cards. In addition, you can pay balances due on your account securely via credit card using the Online Bill Pay link on our website (certifiedallergy.com).

Credit Card on File Program

We encourage all patients to enroll in our “Credit Card on File” program and authorize Certified Allergy to charge your credit or debit card each month for amounts due from you after your insurance plan processes our claims. You may place limits on the amount that can be charged without further authorization from you.  We will send you a statement detailing all amounts paid under the program.

Statements and Payment Expectations

Certified Allergy generates and mails account statements every 4 weeks.  All outstanding account balances are due within 21 days of the first statement. For all subsequent statements, a $5 statement fee will be added to the amount that you owe. We maintain separate accounts for each patient, and generate statements for each patient’s account.

General Credit Policies and Payment Plans

If you know that you will not be able to pay your bill, please contact our Business Office at (518) 434-1456 (ext. 3280) to discuss payment options which may be available to you.

Balance Collection Efforts and Discharge for Non-Payment

If you have an outstanding past due balance, we may send your account to an outside collection agency to assist us in contacting you and obtaining payment. All of our efforts to obtain payment, whether performed internally or by an outside third party, will comply with all applicable regulations.  If your account is turned over to our outside collection agency due to non-payment, you will be discharged from our care and receive notice of such discharge.  Following discharge, you will not be able to receive care from our office.

Financial Responsibility

For patients 19 or older, the responsible party is presumed to be the patient. If another party is responsible for a patient’s medical costs, please provide us with that person’s name and contact information.  In the case of minor children, we will presume that either of the child’s parents is financially responsible for the costs of their medical care unless we are provided with information that specifically designates one parent as the responsible party (see next paragraph).

Families Divided by Separation or Divorce

We understand that families divided by separation or divorce may have specific billing requirements. All efforts will be made to comply with these requirements if they are known to us in advance.  We will attempt to collect any account balances from the parent designated as the responsible party.  That person will receive account statements and other correspondence regarding the child’s account status.

Referrals

If your insurance plan requires a referral from your Primary Care Provider (PCP) for specialist services to be provided by our Practice, it is your responsibility to obtain the referral for the appropriate dates of service. Failure to obtain a valid referral for our services in advance may result in denial of coverage by your insurance company.  The balance of charges due on those services will become your responsibility at the time of denial by the insurance company.

Bounced Checks

If your bank returns your check payment to us due to insufficient funds in your account, we will charge you a bounced check fee of $25.

Thank you for understanding our Financial Policy. Please let us know if you have any questions or concerns.

 

 

Revised April 2016