Financial Policy

Palmetto Pain Management is dedicated to serving our patients with the highest quality of care at the lowest possible cost. We ask that you help keep our fees at a competitive level by observing the following financial policy.  We encourage open discussion with our billing office of services and fees prior to treatment.  It is your responsibility as our patient to see that all charges are paid.  You may speak with our billing staff by calling 803.808.8070 or toll-free at 800.427.7487.

Since insurance plans vary, we recommend that you be familiar with your plan benefits as they relate to deductibles, co-pays, non-allowed charges, and pre-certification. Your insurance coverage represents a contract between you and your insurance carrier. If you have an insurance policy, such as an HMO/PPO that requires pre-certification / pre-authorization or referrals for any service, including office visits, it is your responsibility to obtain it, update it, and keep them current. If you need any help, our staff will be more than happy to help you through the process. In your insurance card there will be a telephone number, which is the number that you should call for pre-approvals or information on deductibles, co-pays, allowable, and pre-certification. You can also use this number to find out what your insurance company allowable is, for the proposed treatment. If you have any questions about the requirements of your coverage, please contact your employer or insurance carrier. We cannot interpret policies for you. Remember that the difference between the allowable and the cost of the treatment will be your personal responsibility. You will be responsible for services rendered that are outside the scope of any referral issued by your insurance carrier. You are expected to be aware of any and all conditions of your insurance coverage. Please provide us with information on any secondary insurance coverage that you may have, as they may cover the difference.

Your co-pay is due at the time of your visit and may be paid in cash, with a check, or by credit card.

No one can reverse a denial for coverage more effectively than the patient.  If your insurance company has denied coverage for the proposed services, our physicians will be more than happy to write a “Letter of Medical Necessity”.  Despite this, some companies will continue to deny coverage, in which case, it becomes the patient’s responsibility to try to overturn the decision, otherwise, the responsibility for payment becomes entirely yours.  We will provide you with the information necessary for you to request a review of a denied claim, or to follow up on disputed claims.  It is your responsibility to follow up on any outstanding claims, and to see that your carrier pays promptly.  Claims status does not relieve you of your responsibility to pay your bill.  Be aware that for some insurance carriers, granting authorization for treatment, does not mean that they will actually pay for it.  Denial of payment after pre-approval or authorization will make you responsible for the charges.

Filing claims with and accepting benefit assignment from your insurance company is a courtesy to patients provided by many physician offices.  However, an increasing number of physician offices require full payment at the time of service and the patient is responsible for securing payment from the insurance company.  When a medical practice chooses to help patients by filing for insurance payments, the result to the physician is that he often waits 45 days or more for payment.  Palmetto Pain Management has chosen to continue to work with insurance companies for as long as possible to make it easier for patients to receive the specialized healthcare they need.  This means both our patients and we have certain responsibilities.

Our Responsibilities

·         File claims with insurance companies in a timely manner

·         Send appropriate documentation of procedures and medical necessity when necessary

·         Post payments received in a timely fashion

·         Send statements of account activity and patient balances due in a timely manner

Your Responsibilities

·         Provide us with current insurance information

·         Provide us with current information on your secondary insurance

·         Update our office when insurance coverage and personal information changes

·         Obtain pre-certification for services from your insurance carrier (telephone number is on your insurance card)

·         Pay co-payments and unmet deductibles at the time of service

·         Pay outstanding balances when you receive statements

·         Work with employers and insurance companies if collection from insurance companies becomes a problem

·         Stay in touch with our billing office regarding your account

To help us provide the most efficient and reasonable health care services, we need your insurance information to be accurate, complete, and up-to-date.  If we do not received payment from your insurance company within 30 days, the balance due is your responsibility.  Therefore, you may receive a bill after those 30 days.  If we receive duplicate payment from the insurance company, we will promptly refund to you any overpayment.

We ask that you pay ahead of time on the balance or any unmet deductible that is your responsibility.  For Medicare patients, we will wait until we have received payment or other response from Medicare before billing you for any remaining balance due.  Since we are not a party to the agreement between you and your insurance company, we ask that you assist us in contacting them if they have not paid for your services within 30 days.  If you perceive that your plan does not pay benefits as dictated by your insurance contract, we suggest you contact the insurance company directly.  We regularly review our fee schedule and believe our fees to be reasonable; therefore, we will not become involved in disputes over usual, customary, and reasonable charges, as determined by the insurance company.

For Worker's Compensation claims, it is our policy to bill your employer or the Worker's Compensation carrier for services rendered.  However, you must bring proof of acceptance of the claim, complete billing information, and authorization from the compensation carrier. Otherwise, you will be responsible for all fees incurred.  If you are covered, we will accept the payment made by Worker's Compensation as payment in full.  If Worker's Compensation denies payment or goes into litigation, the entire balance will become your responsibility and will be due within 10 days of the date of the denial.  We will, however, as a courtesy, bill your private health insurance plan, if you provided us with the appropriate information at your initial visit.  For this reason, and for your protection, we ask that you provide complete information on all your health insurance at the time of your initial appointment.

We do not hold bills for pending litigation or bill attorneys for services rendered to patients.  Presenting a letter or representation from an attorney does not alleviate you of the responsibility for your bill.  If your treatment is required as a result of an accident, and your health insurance has agreed to cover it, we will file your group health insurance.  If your health insurance carrier will not cover our charges because of third-party liability insurance, we will expect payment in full at the time of service.

If you do not have any health insurance and are not covered by Medicare, Medicaid, or Workers Compensation, you will be considered a "Self Pay" patient.  Payment is due at the time we deliver services to you, and we require that you make payment in full at the time of your visit.  This assists us in reducing billing and operating expenses that inevitably get passed on to patients.

If you anticipate balance due creates a financial hardship, we will be happy to work with you to establish a monthly payment plan.  Your need for potential payment arrangements should be discussed before services are rendered.  Payment plans may not be set up once accounts reach delinquent status.  The agreed on amount must be paid monthly, or the account balance will become due in full.

A Charge may be incurred for missed ("No-Show") appointments unless you have provided prior notification of your inability to honor your scheduled appointment at least 24 hours in advance.  There will be a charge for filling out forms, reports, and phone calls answered by physicians.  Payment will be due, along with your co-pay, at the time of your next visit.  You may pay this by using your credit card.

We ask that you read this policy and assist us in keeping our costs down by ensuring that we can be paid on a timely basis for our services.  We welcome the opportunity to discuss with you any aspect of our financial policy.

To help us fulfill this policy, we ask that you assist us by:

1.       Providing us with current and updated information on yourself and your insurance coverage and advise us immediately of any changes in insurance coverage, personal address, etc.

2.       Making payment at the time of service for the entire balance if you are a "Self Pay" or “Self-Insured” patient or for the amount of the deductible or co‑payment, if you have insurance.

3.       Keeping your balance current or continue to make regular monthly payments on your balance.

4.       Discussing your account status and balance only with the check‑out staff or our billing staff.

Please do not discuss the financial aspects of your care with the physician(s).  It is important for them to be allowed to practice medicine and provide patient care.  Our professional billing staff is familiar with our services and with all of the insurance plans with which we participate.  Please call them at 803.808.8070 or toll free at 1.800.427.7487 anytime you have questions about your coverage or your account.