Office Information: Credit Policy

Credit Policy
It is your responsibility to make sure the physician you choose is approved by your insurance company or employer before seeking treatment with a Westside doctor.

Worker's Compensation
To file workman's compensation, you must have notified your employer prior to the appointment. We attempt to pre-authorize by phone for all work related injuries prior to seeking the doctor. If we are unable to obtain authorization and you do not bring a written authorization with you the day of your first appointment, your account will be treated as private pay or filed with your private insurance. All follow-up care requires authorization by your employer.
If you have any questions regarding your work related injury authorization, please contact our Occupational Health Director, Sue Gaul at 563-583-0892.

Medicare Only
We are a participating Medicare provider and will file your claim for you. Once payment has been received, we will bill you for your annual Medicare deductible. This is your responsibility to pay.

Medicare & Supplemental Insurance
We will file your Medicare claim and any supplemental insurance you may have. Any balance remaining after your insurance has paid is your responsibility. Please make sure we have an up to date copy of your supplemental insurance card.

Medicare & Medicaid
We will submit claims for Medicare and Medicaid patients. You must bring your current eligibility card with you at the time of each appointment. This card must be current. If you do not bring your card, your appointment will be rescheduled. We participate in several Iowa and Illinois Medicaid programs. Please contact our Insurance Department prior to your appointment date to verify provider eligibility for your specific plan. Other out-of-state participants should contact the Business Office prior to the appointment date.

Disability Forms
There is a $16.00 per form charge for disability form completion that are not directly requested by your employer. Payment of this fee will be collected upon receipt of the form by our office. All forms will be sent directly to the insurance company. A copy will be provided upon patient request.

Pre-Certification vs. Pre-Authorization
Your health plan may or may not require pre-certification. Many insurance carriers require pre-certification to validate the medical necessity of a test, surgery, or impatient hospital stay. The nursing staff will make every effort to complete the pre-certification requirement on your behalf, but, ultimately the responsibility is yours. Pre-Certification is not a Guarantee of Payment. If you have any concerns regarding your benefits or coverage, please contact your insurance carrier. You may want to have a procedure Pre-Authorized by your insurance carrier to ensure you receive full benefits. This requirement may be mandatory for certain elective procedures as dictated by your insurance carrier. We strongly encourage our patient's to have a thorough knowledge of their health plan benefits and to call their carrier with questions regarding their coverage.

Credit Policy
The following credit policies and instructions were made after careful consideration and are necessary for a good doctor-patient relationship. These policies must be followed by all patients in order for us to continue to provide the medical care and service you and your family want and need. Failure to adhere to these policies will result in a delinquent account and the necessary steps for collection will be initiated. WESTSIDE ORTHOPAEDICS WILL NOT HOLD ANY OTHER PARTY RESPONSIBLE FOR PAYMENT OF SERVICES YOU RECEIVE. YOUR BIL IS YOUR RESPONSIBILITY. Please let us know if you have any questions regarding these policies. To avoid misunderstandings, we invite you to discuss your financial concerns early.

Your Appointment Day
The day of your first visit, and any time there is a change, bring all current insurance cards with you. We will want to make copies for our records. Please let us know of any changes in address etc. Plan on paying any deductible or co-pay your insurance may require. At the time you are seen, a preliminary bill will be issued. This is done to give you an idea of what your responsibility is at the time of your visit. THE AMOUNT OF YOUR FINAL BILL MAY DIFFER. Your final bill will be sent to you in the mail.

Deductible & Co-Pay
Depending on your insurance, you may be required to pay toward your deductible and any co-pay at the time of your visit. Please make note that some tests and procedures are quite expensive and may have a large co-pay. Once these are scheduled, please contact our Insurance Department to make financial arrangements. ALL accounts are due and payable within 30 days of the first statement after your insurance has paid. We accept MasterCard and Visa, cash, checks, or money orders.

Paying your Bill
Prompt payment of any remaining balance after your insurance has paid is expected. Accounts not paid within 90 days will begin to accrue interest at the rate of 1.5% per month. If you need to make special arrangements, please contact our Billing Department. A $25.00 service charge will be collected for returned checks.

Patients with Health Insurance
We will be happy to submit charges to your personal health insurance company. You are responsible for providing us with the correct name, address and policy numbers of your insurance, and any changes that occur during your treatment. If your insurance company sends you a questionnaire, please complete and return it promptly or you will be asked to pay the bill directly. If an insurance payment is received and there is a remaining balance, you will be billed for this amount. If payment is delayed beyond a reasonable amount of time, you will be expected to make payment. If Westside does not have a contract with your insurance company, and payments will be sent directly to you, you will be required to follow the provisions for individuals without insurance. We will file your insurance as a courtesy, however, you are still responsible for the bill. Please be prepared to pay any deductible and/or co-pay you may owe at the time you are seen.

Hospital/Outpatient Charges
Emergency Room, Surgery or Impatient charges - It is the patient's responsibility to make arrangements for payment of their bill. If another party's insurance will be paying your bill, please notify our Business Office as soon as possible at 563-582-2882 ext. 510 and provide the insurance information.

*Your insurance policy is a contract between you and your insurance company. We cannot guarantee that insurance will pay your claim. It is very important that you understand completely the provisions of your individual policy.

*If your insurance company fails to pay your claim, they should explain to you why it was rejected. If you are dissatisfied with their rejection, or the amount they pay, it is your responsibility to take the matter up directly with your insurance company. We will be happy to file an appeal on your behalf, but please do not blame the Clinic, or jeopardize your credit rating by not paying your bill.

Patients without Insurance (Self-Pay)
Office charges, x-rays, lab, etc., are payable at the time services are rendered. Patients needing surgery are advised to talk to the Insurance Department staff before scheduling. It will be necessary for you to bring cash, check, MasterCard or Visa at the time of the visit.

Liability Insurance
If you are injured in an AUTOMOBILE, MOTORCYCLE or OTHER PERSONAL INJURY ACCIDENT, and another party's insurance company will be paying your bill, please furnish our insurance department that information promptly. Please remember that you are the one seeking treatment. We will bill these other insurances, but Westside Orthopaedics holds only you responsible for the bill. Your account must be kept current. We do not routinely hold accounts open while you wait for a settlement. Please contact our Insurance Department to make arrangements.

Managed Care Insurance
We participate in several managed care plans including Health Maintenance Organizations (HMOs) and Preferred Physician Organizations (PPOs). We are not a member of Medical Associates HMO. Employers and insurance companies frequently change plans, networks and provider relationships. Please make sure that our physicians are approved for your care.

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Last Modified: November 5, 2020