2019 Billing Evolution at Mountain Spirit

 Every New Year brings change.

Mountain Spirit is updating our Insurance Billing Policies, and we want you to be the first to know:

We are a modern, progressive, and integrative health care clinic. While a growing number of local clinics have stopped accepting insurance, we’re remaining Contracted 'In-Network Providers' with the very same NM Health Plans we’ve welcomed for years. We will continue the courtesy of billing plans that cover our service(s) in a timely manner. To streamline our billing procedures for our Patients, improving accuracy and efficiency, we now require patients to place a credit card on file in our securely encrypted database. This system is used to apply Patient Shares, for any balance that remains unpaid by a Patient one week after we have sent a detailed email notification of the balance due. This provides a paperless process, reflective of our commitment to our environment and your time management.

By visiting Mountain Spirit in 2019, you understand and agree to the policies described here. By electing to visit our Providers and signing our Intake Forms, you also agree to pay the portions your insurance deems to be your “Patient Responsibility” as outlined in your agreement with your contracted health insurance or self paying portion of services at MSIM, and you agree to receive this information by email.

For Patients Using Insurance for Service(s) Covered by their Health Plan, for which we are Contracted In-Network Providers

SUMMARY OF THE PROCESS

*When a CoPay is due for any service(s), only those amount(s) will be due and collected upon checking in for your visit(s).
*We'll continue to bill Health Plans in a timely manner, and wait for their reply.
*If your Insurance reports any further amount due, we'll email a summary of the Patient Share on the EOB. We provide you 1 full week from the date of that email to either pay online; or contact us to update your then-preferred payment method for automatic Patient Share payments.
*In case you’re either too busy to pay within a week, or prefer we do it for you, only then will we charge the remaining Patient Share due to your card on file.
*In order for this system to work we require all patients utilizing health insurance for medical care in 2019, to place a credit card on file in our securely-encrypted database.

DETAILED PROCESS

In the past, patient statements were generated and mailed on paper, as it was the only option available. With advances in technology and our commitment to our shared environment, we will now communicate statements due via email.

  • For each date of service, we send an electronic claim to your insurance in a timely manner. While insurance company policies vary, most require these claims to be submitted within 90 or 180 days. This new efficient system allows us to submit claims in less than 30 days (on average).

  • Your insurance then has up to 60 days to processes the claim. They apply your policy agreement to the services we provided, and generate an Explanation of Benefits which is sent to you as their member, and our Clinic as the Provider.

  • Be sure to read each EOB your insurance sends to you to know just how your claim was processed. The “Patient Share” or “Patient Responsibility” amount on your EOB is the total amount your insurance company deems you are responsibility to pay.

  • Any “Patient Share” amount that is more than what was collected for treatment on the stated Date of Service, is due by the patient. We'll email a summary of the Patient Share from your insurance plan’s EOB, and provide you 1 full week from the date of that email to either send payment online, or contact us to update your preferred method for automatic payments.

  • Only if payment is not made by you within that time period (or you prefer that we make the payment for you), we will charge the remaining Patient Share due to your card on file, and send a receipt by email.

These changes will streamline the billing process, simplify communication of any Patient Shares due, and make paying those portions more convenient for you!

Did your Insurance Company possibly make an Error on your EOB?

The insurance plan in which you are a member, is an agreement solely between you and your insurance company, regulated by State and Federal law. No clinic can be held responsible for your health plans’ member agreement, nor how your insurance company processes claims.

If for any reason you believe you have found an error on your EOB, in which your insurance company has inaccurately calculated the Patient Share due based on your member agreement, or your understanding of your plan’s benefit is different than what you find on the EOB; then it is your responsibility to contact your insurance company and notify them in a timely manner. (Each insurance company is different in defining what is timely, so be sure to contact them via phone or in writing to learn what you agreed upon when enrolling in the plan.) Typically when calling, you will need to request that they reprocess your claim based on the rationale you find.

If your Insurance Company finds they have made an error, here is the process that will occur:

*Your insurance plan may send a Corrected EOB to both you and our clinic. For accuracy, we must receive a Corrected EOB from your Insurance Company and enter it into our system.

*If they find your original Patient Share was over the correct amount, and acknowledge they should have paid more for the claim, then they owe an additional amount payable to our clinic as the Provider.

*Within 30 days of receiving both the Corrected EOB, and receiving additional payment from your Insurance company for the date of service, we will update your account and email you with an updated statement for the affected date(s) of service.

*If you are due a refund of any amount on your account here at Mountain Spirit, we will inform you of the dollar amount due and inquire how you would like to receive it. Within 1 week of receiving your instructions via reply email, we will have your refund ready and/or sent in the method you instructed.

For Patients receiving any Self Pay service(s):

Payments for Self Pay services are due at the time the service is provided.  Balances will be charged to the credit card we have on file the same day of service if payment is not made to the front desk. We will charge your credit card on file and send a receipt by email. 

For Late Cancelations and No Show fees

 Late Cancelation and No Show fees will be charged the date the LC/NS fee is incurred. To ensure our patients do not incur these fees, our email and phone call reminders go out 48 hours prior to all appointments, which provides you an extra 24 hours to cancel or reschedule appointments without incurring any fees. If you need clarification of our LC/NS fees, please see our Policies page on our website.

Self-Pay products such as Herbs, Homeopathy, Liniments & Devices

Payment for home care items (herbs, homeopathic remedies, liniments, tinctures, etc.) is due at the time items are purchased. These items often qualify for FSA Flex Cards - ask the front desk for receipts to submit to your FSA benefit administrator. If payment is not made to the front desk at the time you take them home, any outstanding balance due will be charged to the credit card we have on file, with a receipt sent by email.

Important Checklist for Every New Plan / Year:

Did you receive a new insurance card? Call our office as soon as you are able with your new insurance information in your hand. This will help ensure your bills are processed in an accurate and timely manner. We'll enter your new insurance information and verify your benefits. We will send an email with your benefit information; your copay/coinsurances for the year, your deductible amounts if they apply to our services, and any plan limitations, as reported by your insurance plan. Please read them carefully! Each patient is responsible for knowing their limits, benefits, and deductible information for their individual coverage.

Did your Health Plan change your insurance plan for services in our office this year? Contact us, so we may help you understand how this may impact your Patient Shares. If any service is no longer covered, you may sign our Opt Out form, and Self Pay just for the non-covered service(s).

Copays, deductibles and visit limits may have changed. Verify what portions you will be responsible for so deductibles and coinsurances will not be a surprise. Talk with your Health Plan Customer Service, your Insurance Agent who connected you with the plan, or Human Resources / ‘Plan Benefits Administrator’ to answer specific questions.

Are you still reading this? You’re an informed Patient. Enjoy the gifts of Wellness every season!