Office hours and appointments:


9am to 5pm, Mondays through Fridays. Monday mornings are our busiest time. If you call and get a busy signal and IF IT ISN'T AN EMERGENCY, try again a little later, or that afternoon.
We have taken on extra staff to assure calls are answered promptly.

Support Staff:

All our staff are courteous, friendly and efficient. They will help you in scheduling appointments and procedures and will help you with your insurance forms and payment schedules.
Lynn is our office manager and in charge of scheduling, Mary Alice and Jessica run our front office and deal with collecting patient and insurance information, and making appointments,
and Marilyn does our nursing, assists the doctors, and does minor patient care.
Although it may seem like an awful lot of paperwork, getting accurate patient information (such as medications and past surgeries), and exact insurance information are VERY important
to delivering the best care we can, and steamlining any payment issues.

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UNDERSTANDING YOUR INSURANCE & OUR OFFICE POLICY

The following information was designed to educate our patients about many of the different and often confusing insurance policies, and what our office policies are regarding them. Ultimately, it is the patient's responsibility to understand their individual plan. However, please feel free to ask any member of the staff for assistance.

GENERAL GUIDELINES:

Each insurance policy is unique, and our office will find out and explain what your coverage is to best serve you. We aim to get you better with minimal or no financial burden.
Your policy's coverage may be much better than you have been led to believe. Let us find out.

1. Payment is due at the time of service. This includes copayments.
2. The patient is always responsible for any deductibles, copays, and coinsurances regardless of what insurance you may have. This is the law.
3. An ORIGINAL up to date referral must be provided on the day of the visit by all patients who require referrals. There are no exceptions.

GENERAL DEFINITIONS:
Participating Plan-
When an office has a signed contract with the individual insurance company and agreed to submit the claims and accept payment directly from the plan. Once again, you are responsible for any deductibles, copayments or coinsurances. Englewood Surgical Asssociates does not participate with any plan but the hospital based Qualcare,

Non-Participating Plan- Means that our office does not have a contract with the insurance carrier. You may well have out of network benefits/coverage, with which we can work. Some payment may be required at the time of visit, but not in all cases.

HMO Patients- Health Maintenance Organizations require the patient to obtain a referral from his/her Primary Care Physician before being seen by a specialist. No coverage is available when members do not access care from their Primary Care Physician first. Some coverage is almost always provided out of network for emergency care & is accepted by our office.

PPO Patients- Patients can see a participating physician without obtaining a referral.

POINTS OF SERVICE (POS)- This is when you have the option of either obtaining a referral from your primary care physician, or being seen by a participating physician without a referral. You have an out-of-network option.

Traditional Non-Participating Plan (Indemnity)- The office does not participate with your plan. You will be given a form that you can submit to your insurance carrier and you will be reimbursed. Payment may be required at the time of visit.

Traditional Participating Plan (Indemnity)- The office participates with your plan. The office will submit your bill to the insurance company. Payment is not required at the time of the visit, BUT you are responsible for your deductible and coinsurance payments. The office will mail you a bill for your responsibility, which is determined by your insurance policy.

Noncovered Service- These procedures which your insurance company considers medically unnecessary, such as cosmetic procedures, & varicose vein injections. Payment is required at the time of the visit and we will discuss the fee with you.

Medicare- Englewood Surgical Associate Physicians participate with Medicare. We will submit the claim, and we will send you a bill for your responsibility. If you have a secondary insurance that is not a Medicare Medigap Insurance or if it is one that we do not participate with, you will be responsible for the 20% of the bill at the time of the visit.
Medicare HMO: this form of medicare provides the least choice for patients and lowest payment to physicans and will not pay for elective care by out of network doctors.

REFERRALS
Referrals are requited for HMO and POS participants who want to stay in network. As a COURTESY to our patients, we try to remind you when you need a new referral. However, it is ultimately your responsibility to make sure your referral is up to date.

Please remember that the original referral is required at the time of visit. Fax referrals are not accepted, since insurance companies do not accept fax referrals. Post dated referrals cannot be accepted.

If you choose to be seen without a referral and you have an HMO with no out-of-network plan, then you will be responsible for that day's bill at the time of the visit, and you will be asked to sign a financial release waiver. If you have POS insurance, you will still be asked to sign a financial release waiver. NO EXCEPTIONS WILL BE MADE.

PAYMENT
Payment is due at the time of visit. This means the entire bill if we do not participate in your plan. Copayments are due at the time of visit.

Medical Insurance can be confusing and frustrating for all involved. We are happy to help you understand your policy. Please understand that we need to follow the rules of your insurance, so that we can ensure that you are covered properly and reimbursed. It is our pleasure to assist you and your family.


PLEASE UPDATE US WITH ANY INSURANCE CHANGES

This list is subject to change, please verify insurance with office staff when you make your appointment.

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