Your Visit
Here's everything you need to know to get the most out of your visit to Upper Cumberland Urology.
- Current list of medicines you are taking (prescription and over-the-counter)
- If you have had X-rays, MRIs, CAT scans, etc., please bring a copy of the CD or films.
- Current insurance card(s)
- Driver's license or other picture ID
- Copy of power of attorney, if applicable
- Co-pay, if applicable
- Forms you completed from our web page
- You might want to make a list of questions you want to ask the provider when in the room with them.
Other Information
We accept most major credit cards, debit cards, cash, and personal checks.
Upper Cumberland Urology — Insurances Accepted as of 1-1-10
Please note: This list of insurances and networks may change from time to time. Also, we do not necessarily accept all plans under the companies listed. To ensure that you have the most current information on which providers are participating with each insurance company or network, please contact your insurance company at the number on your card.
- Aetna Insurance Company
- Beechstreet Network
- Blue Cross Insurance Company (including Cover TN)
- Bluegrass Family Health Network
- CIGNA Insurance Company
- Coventry Group Health Network
- First Health Network
- Healthspring
- Humana Network
- Medicare Part B
- Medicare PFFS Plans: Blue Cross, Aetna, Humana and Secure Horizons
- Multiplan Network
- Novanet Network (Coalition America)
- Private Healthcare Systems Network
- Pronet Network
- Railroad Medicare
- Signature Health Network
- TennCare Plans: Select, BlueCare, Americhoice and Amerigroup
- TennCare State Medicaid
- Tricare Plans: Tricare Prime, Tricare Standard and Tricare for Life
- UMWA
UPPER CUMBERLAND UROLOGY ASSOCIATES, PC
PATIENT FINANCIAL RESPONSIBILITY AGREEMENT
ALL PATIENTS
Patients receiving care at Upper Cumberland Urology Associates PC are responsible for their own bill. Payment is expected at the time services are rendered. As with any other business, it is necessary for us to receive payment for the services we provide to ensure we can continue providing these services for you at reasonable prices. We understand most patients today have health insurance coverage. As a courtesy to you, we file insurance claims for each billable service we provide. However, we do not accept responsibility for collecting your claims. Our staff is more than willing to assist you in receiving the benefits you are due, but ultimately you are responsible for your bill, including deductible, co-pay and co-insurance. Payment plans may be available for patients needing to make special arrangements to pay off their bills. These arrangements should be made in advance of receiving services. Please feel free to ask questions and discuss financial matters with any of our patient accounts personnel.
- Payment is expected at the time of service.
- ALL co-pays must be paid PRIOR to seeing the physician or we reserve the right to reschedule your visit.
- Payment is necessary to continue providing quality services at reasonable prices.
- Insurance is filed as a courtesy.
- Our staff is willing to assist you, but you are ultimately responsible.
- Payment plans may be available if arranged in advance of receiving service.
- We reserve the right to turn patient balances over to collections and/or dismiss patients from the practice for nonpayment.
- Payment is expected from the parent with the minor child at the clinic visit, regardless of custody arrangements.
- Return check fee is $20.
SELF-PAY POLICY
- Self-pay patients will be required to pay at the time of each office visit. You will be required to pay $130 down payment PRIOR to seeing the doctor or nurse practitioner each time you come to our office. This amount may or may not cover your entire bill at each visit. If there is an outstanding balance after seeing the physician, payment in full is expected, or payment arrangements may be available.
- If you have a procedure/surgery done at the hospital or in our office, you will be given the amount of our doctor’s fees and how much money is required for a down payment or payment in full. Payment arrangements may be available.
- A letter will be mailed to patients seen through the hospital, emergency room, or one of the satellite clinics requesting payment in full or instructing you to call the office to discuss payment arrangements.
- Payment plans may be available if arranged in advance of receiving service.
- We reserve the right to turn patient balances over to collections and/or dismiss patients from the practice for nonpayment.
- Each patient must sign a payment agreement if account is not paid in full at the time of service.
- As long as the patient pays according to the payment agreement, no other collection action will occur.
- If payments are not made according to the Patient Financial Responsibility agreement, then collection will be pursued.
- A Patient Financial Responsibility agreement explaining this policy will be given to self-pay patients seen in our office.
| |
|
