Insurance

FINANCIAL POLICY

We expect payment at the time of your visit unless special arrangements have been made prior to your visit. We will file for you all surgical, and fracture management fees. In other cases, we will give you the necessary information to file your claim. All patients should bring their complete insurance information and insurance card on the first visit. You are responsible for all charges. Any questions or complaints regarding your coverage should be directed to your insurance company. The following additional information may be helpful.

MEDICARE PATIENTS

We are a participating Medicare provider which means we accept Medicare patients and what Medicare pays, and any secondary insurance you may have. If you are currently working and have Medicare, and private insurance, then Medicare may be the secondary payer after your yearly deductable has been met. We file all Medicare claims and secondary insurance.

MEDICAID PATIENTS

You must bring your current Medicaid card with you on your first visit, and on the first of each month you are seen. Medicaid patients are funded by a govern- ment program. All claim forms are submitted by our office. No payment is required of Medicaid patients unless you have used all the visits allowed then you are responsible for your bill.

WORKERS COMPENSATION

Workers compensation must be approved prior to being seen. The appointment must be made by either your employer or the insurance carrier for workmens comp. You will be required to fill out a job injury identification sheet. We file all claims with the South Carolina Industrial Comission. At the conclusion of your treatment or when you have reached maximum medical improvement you will be rated according to the percentage of permanent impairment that you have for the specific job related injury. Other corplaints, and/or injuries not related to the original injury will be paid by the patient, and this should be paid at the time of the visit. No payment is required on Workers Compensation patients. Refiling of claims and payments on workers compensation patients previously filed as non workers compensation is a lengthy process requiring considerable staff time and effort. Our staff have many other important clinical responsibilities that will take priority.  You are encouraged to seek approval prior to your office visit if your injury is work related.

PRIVATE INSURANCE

You must bring your private insurance card with you. The amount of payment of surgical fees or fracture fees by your insurance company depends on the quality of insurance you buy. Our fees are consistent with national averages. You are responsible for the payment in full regardless of any insurance company's arbitrary determination of usual and customary fees.

MCCAIN ORTHOPAEDIC CENTER

MANAGED CARE, ie, HMO's, AND PPO's are increasing in market share in this area. As a member of a managed care plan you have certain responsibilities. You must always bring your membership card with you. We are currently enrolled in the following managed care plans.

  1. PHP-CCP
  2. PPC+
  3. AETNA OPEN CHOICE- US HEALTH
  4. BC/BS STATE HEALTH PLAN
  5. BEACH STREET
  6. CIGNA PPO ONLY
  7. MEDCOST
  8. ETHIX-AFFORDABLE
  9. PROVIDENT PREFFERED
  10. CAPP CARE
  11. COMPANION-BLUE CHOICE
  12.  TRICARE STANDARD
  13.  HUMANA
  14. PHYSICIANS CARE NETWORK
  15. PREMIER
  16. MEDICARE - CARE PLAN PLUS

Each plan specifies covered and non-covered services. You are responsible for your co-payment and deductable at time of visit. Your copay will appear as a separate charge on your encounter form. Other charges are discounted to your insurance company. EOB will omit the copay charge as it is paid at the time of service by the patient to the practice. The insurance company is not responsible for copay. Many diagnostic studies, and most durable medical equipment, and physical or occupational therapy require pre-approval. Second opinions are required for some surgical procedures. Patients may have restrictions on which hospital they may go to, and who they receive second opinions from.

SELF PAY PATIENTS

These patients must bring funds to pay for their visit and x-rays. A payment plan may be possible in unusual circumstances if prior arrangements have been made.

ATTORNEY PATIENTS

Though we do not encourage referrals from attorneys some of our patients have multiple or single injuries where liability is a factor. A letter of protection and a lien against the judgement and patients authorization form must be completed prior to sending copies of medical records for use by the attorney. A fee is charged for duplication of medical records.

GENERAL COMMENTS ABOUT ORTHOPAEDICS

A fracture management fee covers the initial diagnosis of the fracture and the management, operative or non operative, until completion of healing. This includes the management of any complication. This does not include additional x-rays or additional casts. The decision making in fracture management is complex and requires years of training. This fee covers office visits up to 90 days in most cases. X-ray, injections, and cast application are separate charges. Surgical fees are similar and include a 90 day follow-up in most cases. Cognitive skills brought to bear on a particular situation may not have a clear link to the. time involved.Past due accounts are turned over to a collection agency unless there are extenuating circumstances. Those accounts that abuse the system are taken to small claims court.
RSMcC: rp
Richard S. Mccain, M. D.