Insurance / Medicare

Insurance

Insurance plans vary widely in the amount they pay for office visits, laboratory tests and procedures. Review your insurance plan carefully so that you have a good understanding of your benefits. Most insurance companies have a toll free telephone number on subscribers' cards for help with questions about coverage. Our office will cooperate fully in assisting you so that you may receive your maximum insurance benefits. We participate in most insurance plans offered in the New York area. If you have an insurance plan in which we do not participate, we will provide you with a completed claim form so that you can file for your benefits. Please remember to bring your insurance card to each visit. Deductibles and copayments must be paid at the time of service, and old personal balances must be paid before scheduling future appointments. It is important for patients to know their insurance benefits prior to scheduling appointments. Some insurance plans do not pay for preventive health care, including physical exams. If you discover that your insurance company has rejected a claim based on your coverage, we cannot change the coding of the service performed in order to get the claim paid, as this is considered fraud.

Medicare

Our physicians participate with and accept Medicare assignment. This means that we will submit claims for covered services directly to Medicare. Some "Medigap" insurance carriers have agreements with Medicare where Medicare automatically forwards their claim on to the secondary insurer. We do request that patients pay up to their $100 yearly deductible and the 20 percent patient copay at the time of service. Patients are also responsible for paying for Medicare non-covered services (such as physicals) at the time of service. Old personal balances must be paid prior to scheduling any non-emergency medical care. We realize that Medicare is an enormous entity. Sometimes claims are rejected for reasons we can correct. Sometimes claims get lost in the system. If this happens, do not hesitate to notify the billing office so that a claim can be refiled.

Medicare Part D

You've heard a lot about the Medicare Part D Drug Program. If you are a Medicare beneficiary, we hope you've taken advantage of our joint program with UNC's Pharmacy Department to assist in determining the best choice for you. Now that most Medicare patients have struggled through selecting and enrolling with a Plan, we are starting to see increasing confusion over the operating policies and procedures of the different Plans.

Each of the Medicare Part D Plans has its own formulary that identifies the drugs that are covered by that specific plan. In addition, each Plan has a list of drugs requiring prior authorization. This means that the physician must justify the use of a particular drug by providing clinical information and often medical records to the Plan before the prescription is 'approved.' Each plan has a different process for obtaining this authorization and many require documentation that the patient has not responded to alternative treatment options.

We are committed to providing you the best medical care possible. We believe it is your right and our responsibility to provide you with an understanding of treatment options based on likely outcomes and side effects. It is your responsibility to understand what will be covered by your Plan and to provide us with the necessary forms if prior authorization is required. We will do our best to complete and submit these forms in a timely manner and to provide the documentation required by the various Plans. Please be aware, however, that some plans will not 'approve' a particular drug unless specific alternatives have been tried. We will give you our best medical judgment; the choice is ultimately yours to make.