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FAQs: Billing and Insurance

Q: What insurance plans do you accept?

A: We participate with many insurance plans.  Please see Insurance for a list of the major plans with which we currently participate.

Q: Do I need a referral from my primary care physician?

A: If your insurance plan requires referrals, it is your responsibility to obtain it from your primary care physician (PCP).  Many insurance plans issue electronic referrals, so you may not have a written referral.  Talk to your PCP to ensure they have processed the appropriate referral for your visit.

Q: What if you don't participate with my insurance plan?

A: If Cardiovascular Specialists is not a "participating provider" with your insurance plan, and your insurance plan is NOT an HMO, you can still be seen by our office.  However, you will generally have a higher out-of-pocket cost for deductibles, coinsurance, and/or copayments.

Q: I called my insurance company and they told me Cardiovascular Specialists could become a participating provider if you called them at the telephone number they gave me.  Can you do this?

A: Insurance companies make it sound like a simple process to contract with them.  The fact is, it takes a great deal of time and resources before a practice or health system can contract with an insurance plan, and it can then take the plan as much as another 6 months to complete the "credentialing" process for the practice's or health system's physicians. As a Community Specialty Practice of Johns Hopkins Medicine, we participate only with those insurance plans with which Johns Hopkins Medicine has contracts for its affiliated physician practices.  In many cases, it is not financially feasible for Johns Hopkins Medicine to contract with a particular carrier.

Q: I know Cardiovascular Specialists does not participate with my insurance plan now, but will you in the future?

A: Johns Hopkins Medicine periodically reviews the major insurance plans with which it contracts.  Please see the question above for more information about the contracting process. If you have a question about whether we participate with your insurance plan, please contact our Business Office Manager at 443-276- 9003.  If your insurance company tells you that they "are going to be signing a contract with Johns Hopkins Medicine soon," do not accept that statement as a fact.

Q: My insurance company rejected a claim and said the code wasn't covered.  Can you resubmit it with a different code to get it paid?

A: All of our claims are reviewed carefully before submission to your insurance plan.  If we have made an error on the claim, we will correct the error and resubmit it to your insurance carrier.  However, whatever we submit to your insurance company must be supported by the documentation in the medical record.  To change a procedure or diagnosis code just to get the insurance company to pay the claim is fraud; we will not do that. Cardiovascular Specialists codes and bills according to industry-standard coding and billing procedures mandated by both Federal and State (Maryland) law.  While we verify coverage and authorization for diagnostic testing as required by each insurance carrier, it is your responsibility to know the terms of your insurance benefits and what services are and are not covered.  In particular, screening and preventive services may not always be covered by Medicare and/or commercial insurance plans.

Q: How can I make sure my claims are processed quickly and correctly by my insurance company?

A: To help us expedite payment from your insurance company, please make sure you provide a current insurance card every time you come to our office. Make sure the name you register with matches the name your insurance company has. Answer any correspondence from the insurance company promptly, especially if it is about coordination of benefits (when a patient has two insurance plans) and pre-existing conditions. Finally, if you don't understand the explanation of benefits from your insurance company, call them immediately for clarification.

Q: I've never seen this doctor.  Why is he billing me?

A: If the bill is for a diagnostic test in our office, the test itself may have been performed by a qualified technologist, but it is the cardiologist who reads and interprets your test.  We must bill in the name of the cardiologist who provides the service, not the doctor who requests the test. If the bill is for an office consultation or visit and you were seen by our Physician Assistants (PA), the bill may be submitted in the name of the supervising cardiologist, depending on your insurance carrier's rules for billing services provided by Physician Assistants.  In accordance with Maryland licensing regulations, all Physician Assistants work under the supervision of a licensed physician. If the bill is for services while you were in the hospital, one of our cardiologists may have been asked to consult on your care, or he or she may have provided the interpretation for a diagnostic test you had in the hospital, such as an echocardiogram, that was performed by a technologist employed by the hospital.  In this case, the hospital will bill you for the "technical" portion of the test, and our office will bill you for the cardiologist's reading and interpretation of the test.

Q: I don't have health insurance.  How can I pay my bill?

A: If you do not have health insurance, payment is due when billed.  You may pay by check or credit card.  We accept Visa, MasterCard, Discover and American Express.  Click on the "Pay My Bill Online" link here or at the top of the page to make a secure credit card payment on our web page. If you are not able to make full payment for your account balance when you receive your bill, please contact us at 443-276- 9049 to make payment arrangements.

In addition, for patients who have no health insurance we offer a "prompt pay discount" for visits and diagnostic testing services when payment is made at the time of service.  This discount is ONLY available for payment at the time of service and ONLY for patients with no health insurance.  Please contact our financial counselor at 443-276-9049 for more information.

We recognize that current economic conditions sometimes pose financial challenges for many of our patients and their families.  In addition to time of service prompt pay discounts and payment arrangements for larger balances, we offer a Financial Assistance program under which individuals who can demonstrate a financial need are eligible for discounts on their self-pay balances.  An application and supporting documentation are required to be considered for financial assistance. 

Please contact our financial counselor at 443-276-9049 for an application.

Q: I have a balance due after my insurance has paid its portion.  How can I pay my bill?

A: Many of the same payment options are available as for patients with no health insurance.  Please see the question and response above.

Q: Who do I call if I have other billing and insurance questions?

A: Please call our business office at 443-276-6077 for further assistance from 9:00 am to 4:00 pm, Monday through Friday.  You may also contact us online, but be aware that this is not a secure communications portal and is not monitored in real time.  Therefore, we do not recommend that you include time-sensitive and/or personal medical or financial information in your message.

 

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