Patient Financial Responsibility Policy
1. General
A. The patient’s insurance policy is a contract between the patient and his or her insurance company. However, all charges regardless of the insurance coverage are the patient’s responsibility and the patient is ultimately responsible for any unpaid balances. As a courtesy to our patients, Martin Bionics Clinical Care bills the patients’ insurance and makes every effort to ensure that claims are promptly and correctly
processed. Martin Bionics Clinical Care also bills patients’ secondary insurance when patients provide complete insurance information.
B. Patient responsibility payment is expected at the time of delivery. We accept cash, checks, money orders, debit cards, and credit cards (VISA, MasterCard, Discover, American Express). If patient is opting for Cash Pay, a 50% down payment is required before fabrication begins, and the remaining 50% is due at delivery.
C. If you anticipate challenges with paying your bill in full at delivery, please call your Patient Advocate. There are several ways you can pay your bill, including payment plans with Care Credit, and a Patient Advocate will help find the right one for your financial needs. We will also work with you to determine if you are eligible for financial assistance.
D. In the event you do not accept delivery of the final product, Martin Bionics Clinical Care has the right to bill for items used in the process that are unreturnable to the manufacturer. This includes but is not limited to: liners, feet, knees, diagnostic sockets.
E. Refunds for returned devices and delivered services will not include labor and unrecoverable material costs, and will be reviewed on a case-by-case basis by the Finance team.
2. Payment Plans
A. Martin Bionics Clinical Care offers Care Credit for patient responsibility payment plans.
B. If patient requests a payment plan we would be able to offer the following:
– Under $200.00 | Balance due at delivery with Care Credit Option
– $200.00 and over | 6 month Care Credit Option (deferred interest)
– $500.00 and over | 12 month Care Credit Option (deferred interest)
– $10,00.00 and over | 24, 36, or 48 month Care Credit Option (14.90%, 15.90%, and 16.90% respectively)
The full responsibility must be approved by Care Credit. If patient is denied Care Credit and is unable to pay the full
patient responsibility balance at delivery, the case will be elevated to the Finance team for reconsideration.
3. Waiver of Copays and Deductibles
A. It is the policy of this practice to bill all applicable out-of-pocket amounts and to make reasonable efforts to collect such amounts in accordance with our collection practices and procedures. Martin Bionics Clinical Care will not waive copay, coinsurance, or deductible amounts for insured patients, except in the limited circumstances set forth in this Patient Financial Responsibility Policy. Such determinations may be made only after sufficient investigation has been made and it is expected that such waivers will be rare.
B. If Martin Bionics Clinical Care does waive copayments or deductibles for a patient based on the patient’s financial status, we will maintain a record of the information upon which we based this decision. Waivers of copays and deductibles may also be made after reasonable collection efforts have failed to result in the collection of the fees. Martin Bionics Clinical Care will maintain records of what collection efforts have been made for fees waived in these instances.
C. Under no circumstances will our practice engage in any of the following practices with respect to the waiver or lowering of co-insurance and/or deductibles:
○ Waive or lower coinsurance and deductibles that do not meet the requirements outlined in our Policy.
○ Advertise, or in any way communicate to the general public that payments from private insurance, Medicare, or Medicaid will be accepted as payment in full for health care services provided by our practice, or advertise or otherwise communicate to our patients or to the general public that patients will incur no out of pocket expenses.
○ Routinely use financial hardship forms which state that the patient is unable to pay coinsurance and deductible amounts.
○ Charge Medicare beneficiaries or private insurance beneficiary’s different amounts than those charged to other persons for similar services.
○ Fail to collect co-insurance and deductibles from a specific group of patients for reasons unrelated to indigence or managed care contracting (e.g., to obtain referrals or to induce patients to seek care in my practice vs. another provider’s practice who does not waive copays and/or deductibles).
○ Accept “insurance only” or TWIP (take what insurance pays) as payment in full for services rendered.
○ Fail to make a reasonable collection effort to collect a patient’s balance.
B. Financial hardship determinations are based upon a review of household income in relation to current Federal Poverty Income Guidelines. As part of the process, we generally evaluate income levels, employment status, and other circumstances. Insured patients who choose not to have their claim filed with their insurance company are not eligible for our financial hardship assistance program.
C. Upon verification of a patient’s financial hardship, waiver discount will be calculated based on family income compared to current year poverty guidelines.
D. The determination of financial hardship is applicable to the current episode of care. To waive or reduce future payments, the patient must again prove financial hardship. The patient shall sign a Patient Financial Responsibility Statement stating that the practice has reviewed proof of financial hardship, and what bills are being reduced or waived. Hardships may result in the following :
○ Full adjustment of the patient balance
○ Partial adjustment of the patient balance
E. Once the form and accompanying documentation is complete it will be given to the Director of Clinic Administration for review and approval.
