Billing Information

Choosing Health Insurance

Payment Policy — Co-pays and other payments for services being rendered are due upon check-in. Failure to make these payments upon check-in will result in the need to reschedule your appointment unless prior arrangements have been approved by our office. Our office accepts cash, checks, credit cards and debit cards in the form of Mastercard, Visa, American Express and Discover. As part of your new patient packet, you will be asked to sign and date a Patient Financial Obligation Policy which will be placed in your chart and a copy given to you.

Health Insurance — Our practice participates with a large number of health insurance carriers, each with its own rules and regulation. It is your responsibility to supply our office with correct and complete insurance information. It is also your responsibility for knowing about referrals, co-pays, and other administrative issues relating to payment for services. If you are unsure if a service will be covered, you will need to contact your insurance company prior to your visit to our office.

Below is some information about specific insurance carriers.

Self-Pay Patients — Self-pay patients are required to bring a $75 deposit which will be taken upon check-in. The remaining balance for services rendered will be due upon check-out unless prior arrangements have been made with our practice. Uninsured, self-pay patients receive a time of service cash discount for payment in full provided the same day as services rendered. Discounted fees are based on the current year Medicare Fee Schedule allowable amount rounded to the nearest whole dollar.  To be eligible for discounted rate, payment in full is required at the time of service, and Somerset Orthopaedics, Inc. will not file a claim with any insurer.

Workers' Compensation — If your injury is work related, you will be required to complete a worker’s compensation injury form. This form requires you to supply the following information: your employer’s name, worker’s comp insurance carrier, the claim number, the date of injury and the date your employer was notified of the injury. This information must be available at the time of your appointment or prior to your appointment in order for you to be seen. You need to obtain this information from your place of employment. If the information is not available upon your arrival to our office, your appointment will need to be rescheduled. As is usual in our practice, you will be asked to supply us with a copy of your regular health insurance card for your chart.

Automobile Accidents — If your injury is due to an automobile accident, you will be asked to fill out an auto injury form. This form requires you to supply the following information: date of your accident, the claim number, the name, address and phone number of the insurance carrier and adjuster. As is usual in our practice, you will be asked to supply us with a copy of your regular health insurance card for your chart.

Billing For Medical Equipment — It is our experience that many insurances do not pay for orthopaedic devices (braces, splints, etc.). We contract with a private company to provide devices in our office. If an orthopaedic device is given to you at your appointment, the outside company will submit a claim to your insurance carrier for the equipment; however, you may receive a bill from them for any balance of uncovered items. If your insurance company requires you to use a specific brace company, please notify us immediately upon being told you need a brace and we will give you a prescription to take to the supplier covered by your insurance carrier.

Insurance Forms — There is a $5.00 fee for each insurance form that needs to be filled out by our office. Please allow at least three business days for the forms to be filled out from the day they are dropped off. Our staff will automatically mail or fax the forms in when they are completed if they have been paid for up front. A copy of the form will be scanned into your health record. If you are picking the form up, you may be asked to provide photo ID. If you are sending someone else to pick up the form in your place, you must provide a note stating the person’s name who will be picking the form up and that you give them permission to do so. The note must be signed and dated by you and will be scanned into your health record.

Litigation — We realize that many injuries are associated with legal action. Financial responsibility to the doctor rests with the person who is injured and receives treatment, not with the person who is being sued. Therefore, you are personally responsible for all balances due regardless of the status of legal action. Our practice does not bill third party insurances.

CONTACT

126 E. Church Street, Suite 2100
Somerset, PA 15501

Fax: (814) 443-3214
Phone: (814) 443-1281

 

HOURS

M-F 7:30AM – 4:00PM