Insurance & Financial Info

INSURANCE

Contracted Payers:

Health insurance coverage is an important factor in your health care decisions. Our office has carefully chosen to participate with many of the major carriers. We are currently contracted with the following insurance companies and government payors (this may not represent a complete list of all carriers, but the most common ones in which we participate):

• Aetna US Healthcare
• Blue Cross Blue Shield Federal Employee Program
• Cigna
• First Choice Health Network
• Great West
• Department of Labor and Industries
• Lifewise
• Medicare
• Pacificare of Washington
• Premera Blue Cross
• Regence BlueShield
• Tricare West Region
• Uniform Medical Plan
• United Healthcare
• Worker’s Comp Self-Insured Companies

If you do not see your insurance company listed, please contact your insurance carrier to see if we are a participating provider.

BILLING & FINANCIAL POLICIES

Thank you for choosing Bellevue Bone & Joint Physicians for your orthopedic care. We have prepared this sheet to answer the most common questions our patients have regarding our billing and financial policies. If you have any additional questions, please don’t hesitate to ask one of our patient service representatives, or call our patient accounts department at 425-462-9800.

You may receive a surgical bill from each of the following medical providers:

• Overlake Hospital Medical Center or Overlake Surgery Center for the facility fee.
• Bellevue Bone & Joint Physicians for the physician’s surgical professional fee.
• Anesthesia Specialists for the anesthesia professional fee.
• Physician Assistant for the surgical assistant professional fee.

An authorization will be done on the insurance being used for the physician’s fee. If a surgical quote is desired, please contact Sharon in our Billing department at 425-462-9800 ext. 107.

BILLING YOUR INSURANCE

If the reason for your visit is related to an injury or medical condition as a result of your employment, please see our section about L&I Claims. If the reason for your visit was caused by an injury where another party is at fault, please see the Motor Vehicle Accident & Other Third Party Claims section below. For all other visits, we will bill your primary health insurance.

PRIMARY HEALTH INSURANCE

We accept most health insurance plans and will bill directly for our services if you provide us with all of the necessary billing information at the time of service. This includes full legal name, date of birth, insurance identification #, social security number (if insurance requires SS#), group number, insurance name, address and phone number. Please understand that even when insurance is billed, it remains the patient’s obligation and responsibility to ensure payment of fees. If we are provided incomplete billing information, or are unable to verify your insurance coverage or referral authorization (if required), we will ask for payment in full at the time of service. All referrals are the responsibility of the patient and must be received by the time of your visit.

If our office does not contract with your insurance plan, we may also ask for payment at time of service.

CO-PAYS, DEDUCTIBLES, NON-COVERED SERVICES & PATIENT BALANCES

Please be advised that most insurance plans do not cover 100% of your care, and there will likely be a portion of your bill for which you are financially responsible. Most commonly, insurance plans require a co-payment which we will collect at check-in for each visit. It is the responsibility of the patient to know if they have a co-pay. For those patients who do have a co-pay and do not pay at the time of service an additional charge of $20 will be charged directly to the patient for that date of service. Because there are many combinations of insurance plans and varying levels of patient responsibility, we strongly encourage our patients to contact their insurance company directly to determine their specific level of benefits and coverage.

All patient balances remaining after insurance processing are due and payable immediately. Insurance balances not paid within 60 days may be transferred to patient responsibility. After 90 days from date of the initial patient balance, outstanding patient balances will be eligible for transfer to a collection agency. If you have a patient balance, you will be asked to pay in full each time you check-in for an appointment. If you have not already received a statement, we will print one for you upon request. We accept cash, checks, VISA, MasterCard, American Express, Discover Card and debit cards. It is your responsibility to notify us of any insurance and/or address changes. Monthly payment plans for patients with financial hardship can be arranged by our patient accounts department representatives either in person or by phone at 425-462-9800. For any checks returned and marked insufficient funds there will be an additional charge of $25 applied to the balance.

MOTOR VEHICLE & OTHER THIRD PARTY CLAIMS

As a general rule, we do not bill third parties, i.e. automobile, homeowners or business liability insurances; unless you have Regence BlueShield health coverage. We will provide you with the paperwork necessary to receive reimbursement from the third party insurer, but you will be asked for payment in full at time of service. Our office will bill Personal Injury Protection (PIP) coverage through your auto insurance as long as you provide complete claim information. If your PIP benefits become exhausted, we will transfer the charges to your private health insurer. Should this cause financial hardship, please contact our patient account department to discuss your options.

SURGERY SERVICES

Should you have surgery, our surgery scheduler will obtain all necessary pre-certification/authorization. However, this does not guarantee payment by your insurance company. Our office will bill for the surgeon’s fee only. You will receive separate invoices from the facility where your surgery is performed and one for anesthesia. Insurance carriers most often require the completion of an incident/accident report to be completed by the patient prior to processing any claims; it is very important to complete and return this form immediately upon request.

Serving the Bellevue, Kirkland and Redmond Areas