Most frequent questions and answers
Although many medical services are covered under your insurance plan, there are some services that are classified as non-covered services. Each plan defines what those non-covered services are, and describes them in the information given to each plan holder. It is the responsibility of the plan holder to understand their benefits.
There are hundreds of different insurance plans with hundreds of variations as to the benefits offered. Our physicians have no way of knowing each patient’s coverage. It is the responsibility of each patient to know their individual coverage.
Most insurance plans will not cover sports, school, or employment physicals. If you are seeing your physician for this type of physical, you will need to be prepared to pay for the visit.
If a patient is covered under an insurance plan, a claim is generated within a few days of the time the medical services were received. Claims are sent either electronically or by paper, depending on the capabilities of the insurance plan. Claims sent electronically will usually be paid within a 30 day time period. Claims sent via paper will usually take over 45 days before they will be paid.
If a patient has a secondary insurance, the secondary insurance cannot be billed until the primary insurance pays their portion. A claim form is then generated, the Explanation of Benefits from the primary insurance is attached to the secondary claim, and the claim is sent, via paper, or electronically to the secondary insurance. It can take up to 90 days before the secondary insurance pays the balance of the claim.
If there is a portion left over that is the responsibility of the patient, a statement is generated. This could be several weeks before all of the above activity is completed.
Only physicians can diagnose patients. It is illegal to create a diagnosis just to satisfy an insurance company.
Dickson Medical Associates does not have access to your individual benefits. Your benefit information will tell you the amount of your deductible. You can call the number on your insurance card and they will be able to advise you of your deductible. They can also tell you if you have satisfied your deductible for the calendar year.
The amount you were asked to pay on the date of service was an ‘estimate’ only, as there may have been additional charges for tests and other services rendered subsequent to your visit.