Effective Date: October 15, 2022
Thank you for choosing Health Care Remotely, LLC (“HC Remotely,” “we,” “us,” or “our”) to help meet your health care needs. It is important that you understand your financial responsibilities with respect to your health care. We require all patients to sign our Patient Registration form under “Medical Forms” in the practice’s patient portal before receiving medical services.
Patients or their legal representative (“Guarantor”) are ultimately responsible for all charges for services provided. We expect your payment at the time of your visit for all charges owed for that visit as well as any prior balance. You may receive an estimate for your patient responsibility prior to or at the time of your service. If there is a difference in the estimated patient responsibility, we will send you a statement for any balance due. If a credit balance results after insurance pays, we will apply the credit to any open balance on your account. If there are no open balances, we will issue a refund. If you have a large balance, a payment plan may be available.
No Surprises Act/Good Faith Estimate of Charges
If you do not have insurance or are not using insurance to pay for your care, you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the NO SURPRISES ACT, health care providers must give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. This does not pertain to government provided insurance carriers as they must be filed and cannot be used optionally.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least one (1) business day before your medical service or item.
- You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-888-774-8428.
Although our practice is intended for patients with high-deductible health plans or patients paying out of their own pocket (“self-pay”), we may accept insurance in the future. When the insurance plan provides immediate information regarding patient responsibility, we may request payment for your share when you schedule and/or when you present for your appointment. Please contact your insurance company with any questions you may have regarding your coverage.
We will submit your claims and assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not party to that contract.
If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits. If your insurance company does not pay your claim in 45 days, the balance will automatically be billed to you.
You may choose to avoid billing your insurance company for the health care provided by us, knowing your insurance coverage may reduce your out-of-pocket expenses for services delivered outside our company (e.g., laboratory testing, imaging, referrals). Sharing your insurance information with us can help reduce the likelihood that you will be sent for services that are out-of-network for you.
It is our office policy that all past due accounts be sent two statements. If payment is not made on the account, an email and a phone call will be made to try to make payment arrangements. If no resolution can be made, you may be discharged from
the practice. If this is to occur, you will be notified by regular and certified mail that you have 30 days to find alternative medical care. During that 30-day period, our physician will only be able to treat you on an emergency basis.
Self-pay accounts are patients without insurance coverage, patients covered by
insurance plans in which the office does not participate, or patients without an insurance card on file with us. We do not accept attorney letters or contingency payments. It is always the patient’s responsibility to know if our office is participating with their plan. If there is a discrepancy with our information, the patient will be considered self-pay unless otherwise proven. Please ask to speak with the Clinic Manager to discuss a mutually agreeable payment plan. It is never our intention to cause hardship to our patients, only to provide them with the best care possible and the least amount of stress.
As a convenience to you, we can save a credit card on file to settle your account when you check in or out. If you decide to submit the claim to your insurance company, let us know and we will wait 14 days to hear from your insurance company. Once your insurance has paid their share and notified us of any additional amount owed by you, we will notify you that your outstanding balance will be charged to your credit card seven (7) days from the date of the notice. You may call our office if you have a question about your balance. We will send you a receipt for the charge.
This “Card-on-File” program simplifies payment for you and eases the administrative burden on your provider’s office. It reduces paperwork and ultimately helps lower the cost of healthcare. Your statements will be available via your patient portal. If you have any questions about the card-on-file payment method, please let us know.
Methods of Payment
We accept American Express, Discover, Mastercard and Visa. We DO NOT accept cash, money orders or checks.