BILLING AND INSURANCE
The following information will help minimize confusion regarding billing and payment requirements at AVALA Ortho.
Payment Policy and Billing
Payment for services or your co-pay is due at your visit unless arrangements have been made in advance. If insurance information is available before your visit, AVALA Ortho will file your claim. Then, we will only collect the deductible, co-pay or other amount for which the patient is responsible. If not, we will provide a copy of your bill to file with your insurance carrier for reimbursement.
Methods of Payment
We accept cash, check, credit cards (Visa, MasterCard, and Discover), debit cards or money orders.
Insurance and Billing
We will gladly assist in filing a claim with your insurance company. Before we bill you, we bill your insurance provider (including Medicare) and any secondary insurance providers. During this billing process, you will also receive monthly billing statements, so you are aware of any insurance activity. The statement will show that the balance is pending with insurance. We bill all insurances and will verify your current coverage at each visit. Please bring your current insurance card to each visit. If we are unable to verify your insurance, you may be listed as self-pay, which requires payment in full for the service.
Here is a list of AVALA’s accepted insurance plans:
- Aetna HMO, PPO, POS
- Aetna Medicare
- Blue Cross 65
- Blue Cross Advantage
- Blue Cross HMO, PPO, POS
- Cigna HMO, PPO, POS
- First Health Net
- Humana Gold
- Humana HMO, PPO, POS
- Medicare HMO
- Peoples Health Network
- Precision / Signature Plus
- United Healthcare AARP
- United Healthcare HMO, PPO, POS
- United Healthcare Medicare
- Well Care
You may receive multiple bills for the visit depending on the services provided. For example, bills for lab testing will be separate from the physician’s bill.
Referrals and Authorizations
Many insurance plans require that your primary care physician provides a referral. Each plan is different, and it is your responsibility to know the requirements for your plan. We are happy to help you get a referral, but you may be responsible for payment or the appointment may need to be rescheduled if the referral is not received. Most insurance companies also require prior-authorization for specific services such as procedures or some medications. We will work with your insurance company to get authorization; however, the process can take up to 10 business days. We may need to reschedule your appointment until authorization is provided.
Patients are required to cancel or reschedule a clinic appointment with five (5) days advanced notice or ten (10) days advance notice for hospital procedures.
To assist you in keeping scheduled appointments or procedures, AVALA Ortho utilizes various reminder systems which include an automated telephone reminder (Televox), direct telephone calls from staff, appointment card reminders, etc.
It is essential that you keep regular clinic appointments and/or hospital procedures in accordance with your plan of care. If you repeatedly miss or cancel your appointment or procedure, you may not be rescheduled.