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Patient Guide

Billing, Insurance and Payments

Questions

I received a statement in the mail from my physician's office for services provided during my last appointment. Is this a bill?

No, the statement is not a bill. Rather, it is written notification to your health plan that services have been provided.

My bill is not correct. How do I resolve any billing issues?

If you have any questions about billing, please speak directly with Angela Gomez, our billing manager, Monday through Friday at 713-932-0118.

What do I need to know before I schedule my "Wellness/Physical Exam"?

All wellness exams, as defined by your insurance company will be billed to them as preventative care. It is the patient's responsibility to check with their insurance company for covered benefits for this type of exam. We request that you sign a waiver if you are scheduling this type of exam.

In addition, our membership program allows us to do a complete physical exam which is included in your membership fee.

How do I arrange a medical referral?

When specialty care is indicated, the usual practice is to bring in a consultant from one of the various sub-specialties. Dr. Weinstein will advise you when a consultation with a physician from one of these sub-specialties is necessary.

Many insurance plans require prior-authorizations for certain test, referrals, ER visits, and/or treatments. These must be obtained prior to treatment. Without the prior authorization, your insurance company may refuse to pay, and you will be responsible for the charges. It is the patient's responsibility to obtain any referrals at the time of their office visits and to take them to the specialist's office. Our office is NOT responsible for faxing referrals to the specialist's office.

Referrals are given at the discretion of your primary care physician. If you are referred to a specialist, be sure and verify with your insurance company that the specialist is covered under your plan. It usually takes 7 to 10 working days for your insurance company to mail confirmation of the referral to you.

If you have any questions regarding a referral please call 713-932-0118 or contact your insurance company.

How much do office visits cost?

Cost varies depending on the reason for the visit, the extent of the exam and the complexity of decision making in treating the illness. In addition, certain diagnostic tests may add to the cost.

As a general rule an average office visit without diagnostic tests, for an established patient is approximately $85.00 - $135.00.

How much is my co-pay?

Your co-pay varies depending on the type of insurance you have.
To find out what it is look on your insurance card.
If it does not specify on your card, there may be no co-pay. Please check with your insurance company if you are in doubt.

If there is a cost, how do I make payment?

For your convenience we accept credit cards, checks, and cash. There is a $25.00 charge on all returned checks, and we do not accept postdated checks. It is our policy to turn past due balances over 120 days to the credit bureau unless special arrangements have been made. Balances over 30 days will incur a monthly service charge of $25.00 for each month outstanding.

Managed Care Contracts obligate your physician to collect any and all co-pay, deductibles, or co-insurance payments at the time of service. Therefore, co-pays must be made in advance, at the time of registration at the front desk.
However, for any further costs that are incurred during the course of the visit, payment must be received upon conclusion of visit and before leaving the office.

Do I have to pay for my visit at the time of my appointment?

We require that you pay your co-pay at your appointment as noted above.
Only on specific occasions do we require you to pay the "entire" amount for the visit at the time of your appointment. Such occasions would be if you are visiting the area and/or you have no insurance and if you have a deductible that has not been met.

Will insurance pay for everything?

In some instances the answer is yes. It depends entirely on the benefits that you have in your insurance.
We would recommend that you familiarize yourself with your insurance health care benefits. You should have received a Member Handbook from your Plan explaining your benefits. If you have any questions regarding your health care benefits, you should contact the Customer Services department of your health plan.
Although we make every effort to verify your insurance benefits ourselves, we ask that you also, contact your insurance company to see if they will cover the costs of your care and the appropriate steps you will need to take if they don't.

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