• Co-Pays:
  Office co-pays are due at the time of your visit.
• If you are covered by Worker's Compensation (WC):
  Be sure we have your Employer's full address, WC carrier's full address, and claim number.  We will then bill your WC carrier for services rendered.
• If you have Medicare:
  We will submit your claims for you and payment will come to us.  Once we determine the patient's responsibility, you will receive a statement.  If secondary insurance is signed up with Medigap, Medicare will submit this for you.  If not, we will submit claims to your secondary insurance carrier and bill you accordingly after your secondary policy pays.
• If you have fee for service insurance where we are In-Network:
  We will submit your claim, and insurance payment will come directly to us. After any contracted write-offs, you will be responsible for the balance not paid by your insurance carrier.
• If you have Medicaid:
  We will file your claim for services provided, and accept their payment as payment in full.  You are responsible for the co-pay, payable at time of service.  You must present your current Medicaid voucher each month.
• If you belong to an HMO:
  You must have a signed authorization prior to being seen.  All services (office visit, x-ray, supplies, etc.) for EACH VISIT must be authorized.  You are responsible for any co-pay, payable at time of service.
• If you are involved in litigation:
  You are still responsible for payment unless other arrangements are made.
  
  
• For all other insurance coverages:
  Please provide name of insurance company, policyholder's name, policy ID number, group number, and address where to submit claims.  If you provide this information, we will be happy to submit your claim to your insurance company.  If insurance information is not provided, the account balance is the patient's responsibility.  Additionally, you are responsible for any balance remaining after your insurance pays.
• Statements will be mailed to you once each month.  Finance charges begin on balances over 90 days old from the date it becomes the patient's responsibility, amounting to 1.5% monthly financial charge, 18% annually.  If your insurance carrier does not remit full payment, the balance is the patient's responsibility.
• If for some reason you cannot pay your bill on time, please let us know and we will be happy to work out a payment plan with you.
• We are available to help you with any questions you might have concerning your insurance so you may receive maximum benefit.
  
  We accept VISA & Mastercard, in addition to check or cash payments.
  

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For questions regarding your account, insurance claims, or billing, dial Ext. 3590, or you can contact your account representative, assigned by first letter of a patient's last name.

Letter Assignment        Extension

N, S, X                   3007

L, M, O                   3009

I, Q, U, W               3006

H, K                        3010

E, F, G, J, Z           3003

 

P, R, T                    3030

 

A, C, D, Y               3008

 

B, V, Y                    3035

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Prescription refills:  If future refills are needed for medication prescribed to you during your office visit, you may contact our office during normal office hours. No pharmacy re-fills for routine medications are given on weekends or evenings.  Only post-operative medication refills can be filled by our On-Call Physician, and no narcotic refills will be given on weekends or evenings.

Work Release:  If you will be off work temporarily due to your injury, or if you will be returning to work with limitations, please obtain a work release note prior to leaving the office.

Disability forms:  Disability forms are completed upon request.  Be aware that these may take up to a week to be completed.  Please have your portion filled out.

Test Results  (MRI, arthrogram, etc.):  Further diagnostic tests may need to be ordered.  It takes approximately three days for the results to get back to our office.  If you haven't heard from us within a week, please call and talk to the nursing staff.

If you are scheduled for surgery:  The procedure will be explained to you at your office appointment.  You will also receive a preoperative checklist.  If you schedule over the phone, necessary information will be mailed to you.

Pre-Certification:  Many insurances require pre-certification to insure payment for surgery, special tests (MRI), or durable medical goods (medical supplies, braces, equipment).  Patients need to contact their insurance company to verify if their policy requires pre-certification.

Medical Emergencies:  There is a physician on-call during all non-office hours.  Calling our office number will connect you to our answering service.  They will then direct your call as needed.

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Medical Records

Patient files are a permanent part of our clinic and are kept confidential.  Medical information is released upon request with a signed release form.

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Thank You

Thanks again for choosing Nebraska Orthopaedic & Sports Medicine, P.C.  We are dedicated to providing personalized service in an efficient, caring manner.  If you have any questions or problems regarding your medical care, billing, etc. please do not hesitate to call.  Good communication between you and your physician is vital, so do tell us about concerns or questions you might have.  We appreciate your assistance in helping us provide you with the very best medical care possible.

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