Insurance and Payments
Method of Payment
We accept cash, check, VISA, MasterCard, Discover and American Express.
As a courtesy to you we will submit medical claims to your insurance company. Any balance after processing of our claim by your carrier is your responsibility. Your insurance policy is a contract between you and your insurance company. You are responsible for verifying if providers are in-network with your insurance company. We cannot bill your insurance company unless you give us accurate and complete information. It is your responsibility to know your insurance benefits as it may not cover all the services provided to you.
Definitions
Co-Payment: A fixed dollar amount set by your insurance contract that is required to be paid at the time of an office visit. This amount is usually between $15 and $60. All co-pays are due prior to treatment.
Deductible: An annual dollar amount established by your insurance plan that is deducted from insurance benefits.
Co-Insurance: A percent set by your insurance plan that is deducted from your insurance benefits. This percent usually ranges between 10% and 40% and is your obligation to pay.
Self-Pay: A patient that does not have any valid health insurance. You will be asked to pay a $300 deposit BEFORE you will be seen for your first visit and $150 for subsequent visits. A payment plan may be set up for any remaining balance.
- Overpayment will be refunded at the end of your treatment
- Overdue accounts are defined as any balance over 60 days old from the date of service.
Referrals
It is the patient's responsibility to obtain referrals and prior authorizations from an insurance company to Multnomah Orthopedic Clinic. Without this referral, the patient accepts full financial responsibility for all charges.
Work-Related Injuries
We will file workers’ compensation claims with your employer’s workers’ compensation insurance carrier. The claim must be an open and accepted claim. If claim is deferred, you will then be asked to provide your personal health insurance. If your workers’ compensation carrier has not paid your account in full within 60 days of your date of service, the balance will be transferred to your health insurance and any remaining balance will be your responsibility.
Completion of Forms
You will be asked to pay $25 to receive completed forms, such as: AFLAC, FMLA, return to work, disability, etc.
Returned Checks
Returned checks will be subject to a $50 fee.
Past Due and Collection Accounts
You will receive a monthly statement from our clinic for the remaining balance after your insurance pays the claim. Payment will be expected within 30 days of receipt. If you are unable to meet your financial obligations, arrangements will need to be made. Please call our business office at 503-231-7809 if you have financial concerns and need to set up a payment plan. If your account is sent to collections, it will be documented in your financial record, and you will not be scheduled for future appointments without approval from the business office.
Fracture Care Coding Policy
Multnomah Orthopedic Clinic makes every effort to follow the current coding practice for reporting medical services as dictated by the federal government (HCFA - the Health Care Finance Administration) and the American Medical Association (AMA). The regulations can be quite complicated and generate many questions from our patients. The purpose of this information is to clear up any confusion caused by these complicated rules regarding the billing of fracture care services.
A fracture or “broken bone” is most often diagnosed by x-ray and can vary greatly in severity and treatment options. However, for billing and insurance coding purposes, fracture care is listed in the surgery section of the AMA’s coding book and is subject to special Global or Surgical “Package” rules, regardless of whether these services were provided at the hospital or in the office.
An insurance claim for fracture care will typically include as follows:
- An Exam at the documented level for diagnosis and decisions about the best treatment options.
- An X-ray often is used to diagnose the fracture and/or post fracture treatment x-ray to ensure proper alignment.
- A Fracture Code will be assigned based on the site, type of fracture, and whether the treatment is closed or open. Open treatment most often is performed in an operating room at the hospital or outpatient surgery facility. Closed treatment often is done at the emergency room or in the office and may be with or without manipulation. However, all fracture treatment is considered “major surgery” by the Federal and AMA coding systems and will oftentimes be reported as surgery on your insurance company explanation of benefits. Being “seen” in the emergency room or your Doctor’s office does not mean that treatment has been initiated. The initiation of treatment implies follow-up and fracture care will be given.
- The initial work of applying the cast or definitive splint is included in the above fracture code at no charge. Subsequent applications are separately reportable and billable.
- Cast Supplies are reported separately.
- Subsequent Fracture care: Most fractures will require one or more or follow-up postoperative visits which are included at no charge in the fracture/surgical fee if related to the same diagnosis. The postoperative/global days is 90 days.
The things that are not included in the package are:
- X-rays either subsequent, for fracture follow-up, or to evaluate a different diagnosis
- All casting supplies (including those used in the first cast or splint)
- Any replacement cast application
- The evaluation and management of any additional problems or injuries
- The treatment of complications including additional procedures or surgery
