You are here: HomeFinancials

CHARGES

Payment is expected at the time of services.  If your deductible has not been met, or you have a copay with a co-insurance, we will collect this when services are rendered.  We will estimate the amount you owe based on information on your coverage and your charges.  However, you are financially responsible for paying the full amount determined by your insurance company nce they have paid and/or processed your claim.   

Payment  in full is due upon receipt of your statement.  If you are not able to pay in full, you are required to contact the billing office to make arrangements on your bill. 

In the event you submit payment by check and the bank returns the check upaid for any reason, we will add a $30.00 service fee to your account.  All future payments will be required by cash, cashiers check or credit card.

INSURANCE 

Bay Area Urology is contracted with many Insurance Companies including but not limited to Medicare, Blue Cross/Blue Shield, Aetna, United Healthcare, Cigna, Humana and many more.  Being contracted with an Insurance Company simply means that we file the insurance claim for you, and we have agreed to give a contractual reduction or discount when required.  In the event we are not a participating provider, we will file a claim as a courtesy.  Payment, however, is due in full at the time of service.  

The patient is responsible for their co-payment, coinsurance and/or deductible where applicable if not met for the calendar year, as well as insuring that the Insurance Company will pay your claim.  Co-payments, coinsurance and deductibles are due at the time of service.  This office must have a current insurance card from the patient for us to file an accurate claim in a timely manner.  Bay Area Urology cannot file a retroactive claim for charges incurred when a patient does not have a valid referral or has failed to provide correct insurance information.  

As a medical provider, we must emphasize our relationship is with the patient and not your insurance company.  Not all services are always covered under every policy.  It is your responsibility to know and understand the level of services covered under your policy.

If you have Medicare and/or Medicaid coverage of any kind, you must notify us prior to your visit.  This is part of your responsibility with Medicare and Medicaid and failure to notify us of Medicare and/ Medicaid coverage will result in full financial responsibility for services rendered.

PRECERTIFICATION

Bay Area Urology will make every effort to contact your carrier for notification or precertification prior to any hospital admission or short stay surgery.  We will precertify all procedures scheduled thru this office, including admissions, day surgeries and imaging procedures.  Many carriers require specific CPT and ICD-9 codes for approval.  Failure to precertify for specific procedures may reflect an additional co-insurance due from the member, so it is very important that we have correct information at all times.  We cannot retroactively precertify a procedure.   Dr. Wagner schedules surgery at Clear Lake Regional Medical Center and Houston Physicians’ Hospital.  Please be advised that scheduling a procedure or test is a very time consuming task, involving a lot of paperwork.  We ask that you review the scheduled dates for both the procedure and the preoperative testing to make sure these dates are available prior to scheduling surgery. Dr. Wagner does have a financial interest in Houston Physician's Hospital.   In all cases, it is in your best interest to contact your carrier to make sure they do not need additional information from the insured member or patient, and that all requirements are met to insure maximum benefits for you.

REFERRALS

Please present your insurance card(s) to the receptionist upon your arrival.  If your insurance changes at any time, we will require notification of change prior to filing charges, or you may end up being financially responsible.

If you are part of an HMO, POS or any other type of managed healthcare, your carrier will require you have a current referral from your Primary Care Physician to be seen in this office.  The referral must be received in this office before any treatment can be provided.  Most managed plans will have pertinent information on the referral advising the specialist what testing or treatment they will authorize.  Referrals do have a time limit and must be valid for your appointment.  If you have any questions regarding your referral, or the date on any referral received in this office, please contact the office to discuss this.  If your referral is expired, it will not be valid for your visit.  If this should happen, you have the option of paying cash and we will provide you with the appropriate paperwork to file your claim.

If you are part of a PPO (Preferred Provider Organization), please advised the receptionist upon arrival.  We are not obligated by contract to honor any PPO agreement if we are not advised of such coverage in advance. 

As you may know, the above referral rules are not our ideas, but are rules and regulations of your insurance company that you and Bay Area Urology must conform to.