Insurance & Financial Policies
Welcome to San Dimas Medical Group, Inc. The following is a brief description of our financial policy and we invite any questions you do not find answered here.
You will be given a number of forms to complete and sign before you see the provider of your choice. The forms are very important for you total health care and for the successful billing and collection of your insurance.
To ensure that your paper work is processed as expeditiously as possible, you will be asked to to provide our office with the following so please make sure the following insurance information is available at all times:
- A current copy of your insurance card
- A picture ID
- Your full name and address
- Policyholder’s name and address
- Your relationship to the policyholder
- Contract number, certificate number and/or group number
- Name and billing address of insurance company
- Telephone number of insurance company
- Effective date of insurance coverage
Contracted Insurance Companies
We are participating in most major health plans and have current contracts with many PPO and HMO insurance companies as well as government agencies including MediCare. We will bill your insurance, and assist you in any way reasonable to help get your claim paid, provided we have your current insurance information and it is complete. Your insurance may delay and/or deny claim payment pending requested information from you or the subscriber of the plan; it is YOUR responsibility to comply with their request. Any such delays or denials will be your financial responsibility.
If your insurance carrier has not paid your balance within 30 days of billing, we will request your assistance in contacting them and require that you begin making monthly payments to eliminate the outstanding balance. Ultimately, you are responsible for the charges incurred for services rendered.
Non-Contracted Insurance Companies
Medical services considered by your insurance company to be non-covered, out-of-network, or not medical necessary will be YOUR responsibility. We will attempt to verify benefits for services provided, but it is ultimately your responsibility to know your coverage. We will bill your insurance as a courtesy. Again, co-payments and deductibles are due at the time of service. If your insurance has not paid your balance in 30 day of our billing, you will be responsible for resolving the balance on the account.
Copays, Co-insurances, and Deductibles
ALL copays, co-insurances, deductibles and current balances are DUE PRIOR to services being rendered. No exceptions.
No Insurance/Cash
We recognize that some of our patients may be without insurance coverage or choose to receive care from our Physicians even when we are considered a “participating provider” with that particular health plan. Please let us know, in advance, if you are in this situation so we may help determine the best way to handle your account. For the most part, if you do not have insurance, payment in full will be required at time of service unless arrangements have been made prior to the appointment.
Medicare
We are Medicare providers and accept what Medicare allows as our payment in full - less any coinsurance or remaining deductible. Our insurance department will bill Medicare for you as well as any secondary insurance you may have on assignment. Payment for any non covered services and/or supplies will be expected at the time of service.
Obstetrical-Prenatal Care and Delivery
For patients requiring Obstetrical/Pregnancy Care, your insurance will be verified on or before your first visit. A monthly payment plan will be prepared for you based on your insurance coverage. Payments will be required monthly and scheduled to end with your portion paid one month prior to your delivery date.
Gynecological-Surgery
For patients requiring surgery, your insurance will be verified prior to your scheduling of surgery. A payment plan will be prepared for you for your portion. In the case of elective surgeries, your portion must be paid prior to the surgery.
Payment Plan
If at any time you are having difficulty paying your account, we encourage you to contact our office (661-663-4800) to set-up a reasonable payment plan. We have different options, just ask.Billing Statements
Billing statements are mailed once a month for all outstanding balances. If your insurance has paid, or you have no insurance, the balance on this statement is due in full unless prior arrangements are made with our office. If your insurance has not paid within the required 30 days, this statement will provide you with the information you need to follow-up with the insurance carrier for payment. If you have any questions or disagree with your balance, it is your responsibility to contact our office within 30 days. Statements will include balances. If a credit occurs for a prepaid date of service, we reserve the right to reapply that payment if there is an outstanding balance on your account. Any past due accounts may be referred to an outside collection agency, and subject to interest and a negative credit rating with various credit bureaus.
Please note that we accept most credit cards as an option for making payments.
It is our policy to treat all patients in a fair manner related to account balances. We will not waive, fail to collect, or discount any co-pays, co-insurances, deductibles or other patient financial responsibilities in accordance with State and Federal Law, as well as participating agreements with our contract Health Plans.
Occasionally, circumstances arise that make the required payment on your account a severe hardship. Please do not ignore your bill. Contact our office as soon as possible to see what other arrangements can be made. San Dimas Medical Group, Inc. is willing to work with our patients whenever possible.
Returned Checks
Should we receive your check back from the bank for insufficient funds or any other reason, there will be a $25 returned check fee. This fee, as well as the original amount, is due in our office within 10 days after notification. Failure to make good on your returned check can affect your ability to make future appointments. San Dimas Medical Group, Inc. does participate in the County of Kern Bad Check Enforcement Program and will pursue payment on any returned check that goes unpaid.
Form Completion Policy
ALL forms requiring medical review and Physician signature are subject to an administrative fee of $ 20.00 per form. This fee is due prior to the release of any completed form.
Request for Medical Records
We require a written request or a completed medical release form prior to releasing medical records. Requests for medical records are subject to an administrative fee of $ 25.00 regardless of the number of pages. We reserve the right to NOT release any records until such fees are paid. We will download the requested medical records unto a CD. We do not email or fax medical records.
Please allow 7-10 business days, for your request to be completed.
Missed Appointments
We understand there may be times when you might have to miss a scheduled appointment due to other obligations or emergencies. We require notice at least 24 hours, in advance, (excluding weekends and holidays) before your scheduled appointment, otherwise you will be subject to a $50.00 failed fee. That fee is $100.00 for perinatology services, all in-office procedures and surgeries.
Other Information
Over the past years, the federal government has implemented a number of regulatory guidelines regarding billing practices by physicians. These stringent guidelines are monitored through the Department of Health and Human Services Office of the Inspector General (OIG). As a health care provider, San Dimas Medical Group, Inc. has chosen to adhere to the OIG regulations, consequently, we do not offer a “professional courtesy” (i.e., waiving of co-payments or deductibles) to any patient. We have an established fee schedule and we adhere to it.