Financial and Privacy Policy

Updated November 2023

We are an independent practice. Thank you for choosing us.

Our providers are contracted with a limited number of insurance companies. We are happy to see you as an out-of-network provider so that you can access the best quality of hernia care. 

For Consultation and Surgery Appointments:

  • If you are using insurance that we participate in, we will bill your insurance first. You are responsible for the portion of the payment that your insurance company assigns to you. This may be in the form of a co-pay, co-insurance, or deductible. 
  • If you are not using insurance, your payment for our discounted self-pay fee is due before being seen in the office for your consultation and when scheduling surgery.
    • You will be provided a receipt. You may or may not be able to be reimbursed by your insurance company. We will not bill your insurance company.
    • Please note that Medicare patients will NOT be able to submit for reimbursement.

For Surgery Appointments:

    • If you are not using insurance – Complete payment is due before surgery.
  • If you are using insurance – we require a credit card to reserve your surgery appointment. 
  • Patients using insurance typically owe Boston Hernia $500-$1500 for surgery after insurance pays their part. 
  • We will charge your card for your remaining balance five days after sending your second statement. 

 

Health insurance is complicated, so the above serves as a high-level overview. Please continue reading for more detailed information. 

 

We are committed to building a successful physician-patient relationship with you and your family. Your clear understanding of our Patient Financial Policy is important to our professional relationship. Please understand that payment for services is a part of that relationship. Please ask if you have any questions about our fees, our policies, or your responsibilities. It is your responsibility to notify our office of any changes to patient information (i.e. address, name, insurance information, etc). 

Co-pays

The patient is expected to present an insurance card at each visit. All co-payments and past dues are to be paid at time of check-in. We accept checks or credit cards. 

Insurance Claims

Insurance is a contract between you and your insurance company. In most cases, we are NOT a party to this contract. To properly bill your insurance company, we require that you disclose all insurance information, including primary and secondary insurance, as well as any change of insurance information. Failure to provide complete insurance information may result in patient’s responsibility for the entire bill. Although we may estimate what your insurance company may pay, it is the insurance company that makes the final determination of your eligibility and benefits.If your insurance company takes back payment for services, you will be billed directly.

Out of Network Services

If we are out of network for your insurance, you are responsible for payment at the time of service. If your insurance company is not contracted with us, you agree to pay our charges. If you are not using insurance for your visit, we will give you a receipt that you may use however you want. Please note that Medicare does not reimburse for out-of-network providers and requires you to sign a standard contract to work with us.  

Participating Insurances – Please see our website for current insurance we are contracted with

If your insurance plan is one with which we are not a participating provider, we are considered an out-of-network provider.

Referrals and Preauthorization

Certain health insurances (HMO, POS, etc.) require that you obtain a referral or prior authorization from your Primary Care Provider (PCP) before visiting a specialist. If your insurance company requires a referral. You are responsible for obtaining it. If you cannot obtain a referral by the time of your appointment, you will be considered an out-of-network.  You will have the choice of rescheduling your appointment or paying our self-pay consultation fee.

If Surgery is Necessary

Please check with your insurance company to understand what costs you may encounter. Take into consideration that, in addition to the Surgeon’s fees, there will also be hospital fees as well as anesthesia fees. These costs will be billed to you separately by the facility and by the anesthesia provider, as they are separate businesses. On average, patients may be responsible for $500-$1500 for Boston Hernia’s charges for one hernia surgery, including surgeon and assistant fees. 

Self-pay Accounts
Self-pay accounts are for patients who choose not to use traditional health insurance, patients covered by insurance plans in which our providers do not participate, and patients without an insurance card on file with us. It is always the patient’s responsibility to know if our office is participating in their plan. If there is a discrepancy with our information, the patient will be considered self-pay unless otherwise proven. 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. We do not bill your insurance company directly when we are not contracted with them.

Motor Vehicle Accident (MVA) and Third-Party Billing

We do not participate in any third-party billing. Our relationship is with you and not with any third-party liability insurance carrier (auto, homeowner, etc.). It is your responsibility to seek reimbursement from them. We will bill you at our self-pay rate.

Workers’ Compensation

It is the patient’s responsibility to provide our office staff with employer authorization/contact information regarding a worker’s compensation claim at the time the appointment is made. An appointment will not be made until we have all the required information from your worker’s comp insurance adjuster and the appointment has written approval. 

Missed Appointments

Boston Hernia requires 24-hour notice of appointment cancellation. No-show appointments and late cancellations (with less than 24 hours’ notice) may be charged a rescheduling fee of $50.00. 

Patients not going through insurance who do not cancel within 24 hours must pay for the visit before their appointment is rescheduled.

Medical Record Copies

Patients requesting copies of medical records will be charged $20.

Attorneys and Insurance Companies that are not the payors will be charged a $100 fee, plus postage, plus:

$.50 per page. A special handling fee of $10 will be charged if records must be delivered within 48 hours of the request.

Outstanding Balance Policy

It is our office policy to send two statements for the outstanding balances. If payment is not made on the account on time, a delinquency (pre-collection) letter will be sent out. If no resolution can be made, the account will be sent to the collection agency or attorney and may result in possible discharge from the practice.

Regardless of any personal arrangements that a patient might have outside of our office, if you are over 18 years of age and receiving treatment or are the parent or legal guardian of a minor receiving treatment, you are ultimately responsible for payment of the service.

This financial policy helps the office provide quality care to our valued patients. If you have any questions or need clarification of any of the above policies, please contact us.

I have read and understand the Financial Policy and agree to comply. I may request a copy of this policy at any time.   In the office, you will be asked to sign electronically that you reviewed this document.

____________________________________ Patient Signature  ___________ Date

 

____________________________________ Patient Printed Name

 

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