Insurance and Billing Questions

The physicians and staff of Urology Specialists (US) value the trust and responsibility you place in us to care for you.  Our providers recommend care based on the patient’s best interest, which is independent of insurance coverage issues.  We cannot know the benefits and exclusions of each patient’s coverage.  Please be sure to contact your insurance company or employer for this information.

If you need clarification or cannot find your answer here, please call our Billing Office staff at (605) 336-1940.  They can be reached Monday – Friday from 8:00 am – 4:30 pm.

Fees:

Our fees for professional services are consistent with those in the community.  An estimate of our fees for proposed services is available upon request.  US’s fees do not include hospital charges, outside lab charges or other specialty physician charges such as anesthesiologists, pathologists and radiologists.

Registration and Financial Information:

To process claims on your behalf, we must have your complete insurance coverage(s) information, your employment, and your guarantor (another individual responsible).  Please bring your driver’s license or other picture ID to your first visit.  We will update and/or confirm the accuracy of this information at each office visit or other significant service.

Please bring your current insurance card with you for every visit.  It is your responsibility to inform us in a timely manner of any changes to your billing information.  If an insurance company denies payment for incomplete or wrong information, it is your responsibility to make payment in full.  If your insurance company requires a referral form or authorization, it is your responsibility to obtain this from your primary care provider before your appointment at our clinic.

Payment at time of Service:

As a courtesy, we will bill your insurance company for services.  Please be prepared to pay your co-payment (and any non-covered services) at the time of each visit.  We will also collect all previous outstanding patient balances during checking in at your office visit.

Elective Procedures:

We require payment in full prior to scheduling for all elective procedures and related consultations (vasectomies, vasovasostomy, etc.)

Insurance, Health Plans and Medical Benefit Programs:

Our clinic participates with many insurance plans.  Please call your insurance company at the telephone numbers listed on your benefit card.  Your insurance company can inform you if we participate in your insurance or if they will authorize you to receive care from Urology Specialists as an “out of network provider.”  If we do not receive payment from your insurance provider in a timely manner, we will transfer the balance to your responsibility.  We request your assistance in following up with your insurance company to resolve any non-payment issues.

If we participate in your insurance:

We will bill your insurance for you and accept the contracted payment rates.  If applicable, we will collect your co-payment at time of service.

Insurance payment rates may include a portion be paid by the patient – if so, we will invoice you. If the insurer does not provide payment in full according to the contracted amount, the balance of charges is the responsibility of the patient.  You are responsible for any amounts the insurance plan deems not covered (or a non-covered benefit) up to the entire amount.

If we do not participate in your insurance:

We do see patients who have insurance with which we do not participate.  This is also considered “out of network provider” or “non-par provider.”

We will provide a receipt and documentation enabling you to see reimbursement by your insurance.  As a courtesy to our patients we will submit claims to non participating insurers or health plans; however, we cannot extend a discount.  Payment in full is required.  You are responsible for any amounts your insurance does not pay.

Credit Cards:

As a convenience, US accepts Visa, MasterCard and Discover credit cards.

We also accept CareCredit as another form of payment.

Self-Pay:

If you do not have insurance we will collect $300 for new patients/$200 for established patients at the time of check-in.

You will be billed and fully responsible for total charges that exceed this original payment.  Please note:  Cash discount is not available for elective procedures.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services. For more information, click here: Right to Receive a Good Faith Estimate.

Payment Plans:

The Business Office staff will establish payment plans for patient balances greater than $500.  You can send in monthly payments or arrange monthly credit card charges with your authorization until the balance is paid in full.  Please talk to a Business Office staff member for details of our payment plan options.

Additional Information and Fees:

• There will be a $30 fee assessed for all checks returned unpaid by banks.
• We request at least a 24 hour notice if you will be unable to keep your scheduled appointment.  Our policy is to charge $25 for missed appointments unless cancelled at least 4 hours in advance.  If the “no-show” appointment occurs for a scheduled procedure, a $50 fee will be assessed.
• There is a fee for copying medical records except when for continuation of care.  A signed legal release is required.  Please allow at least 1 week for release of medical records.