Patient Responsibility and Billing Policy – Elite Spine and Sports
1. Purpose
This policy outlines the billing procedures and financial responsibilities of patients receiving medical services at Elite Spine and Sports Clinic to ensure clear communication and understanding of payment expectations.
2. Scope
This policy applies to all patients receiving care at Elite Spine and Sports Clinic.
3. Payment Method on File
3.1 Required Payment Method
All patients are required to have a valid payment method on file before their visit.
New patients will not be permitted to book an appointment without a payment method on file
Existing patients will be updated on the new policy upon arrival and a valid payment method will need to be on file if they want to reschedule.
This payment method will be used to cover any co-pays, deductibles, co-insurance, or fees for services not covered by insurance.
Patients will be notified before their payment method on file is charged.
Patients will receive a print or email receipt when their payment method on file is charged.
3.2 Invalid Method of Payment and/or Insufficient Funds
Invalid Payment Method: Patients who provide an invalid payment method will be contacted immediately to provide an alternative payment method. If a valid payment method is not provided within 15 days, the patient may be subject to additional fees and/or suspension of appointment scheduling privileges.
Insufficient Funds: If a payment is returned due to insufficient funds, the patient will be responsible for any bank fees incurred, in addition to the original balance. The patient will be notified in accordance with Section 8 below and must provide an alternative payment method within 15 days. Repeated instances of insufficient funds may result in suspension of appointment scheduling privileges and/or the account being sent to a collections agency.
4. Explanation of Cost Estimate
- Elite Spine and Sports provides an estimate of costs based on the information provided by the patient and if applicable, the patient’s insurance company. This is a courtesy service performed by Elite Spine and Sports.
- The estimate includes patient’s responsibility before and after their deductible is met as well as a cost estimate of other services provided at ESS.
- Actual costs may vary based on the services provided and the final determination of benefits by the insurance company.
- For patients without medical insurance or who choose not to bill their insurance for services at Elite Spine and Sports, an ESS Price list of Services will be provided to the patient.
- ESS will reach out to the patient in advance of their first appointment to review the cost estimate with them and obtain confirmation that the patient has understood the information.
- If a patient is unable to be reached after repeated attempts to be contacted the cost estimate will be explained at reception when the patient checks in for their appointment.
- In all cases, the patient will be held responsible for their incurred charges at the end of their appointment
5. Patients with Insurance
- Patients with insurance are responsible for any co-pays, deductibles, and co-insurance as dictated by their insurance plan.
- Patients must provide a physical Insurance Card (office must scan actual card) and Insurance subscriber’s name and date of birth
- Elite Spine and Sports will bill the patient’s insurance company directly for covered services.
- Any remaining balance after insurance has processed the claim will be the patient’s responsibility.
6. Patients without Insurance
- Patients without insurance are responsible for the full cost of services provided.
- A detailed pricing list is available upon request, and patients will receive an estimate of costs before services being rendered.
- Payment is expected at the time of service unless other arrangements have been made in advance.
7. Patient Informational Responsibility
Patients are responsible for providing accurate and updated contact information, including but not limited to:
- Full name and birthdate
- Complete address
- Contact information – phone, email
- Driver’s License (office must scan actual card)
For patients booking online:
- Front and back of DL and insurance cards
- Upload and email to info@elitespineandsportsclinic.com
- Email subject line: APPT DATE, First Initial. Last Name (ex: 07/02/23 T. Swartz)
For patients booking over the phone:
- Front and back of DL and insurance cards
- Upload and email to info@elitespineandsportsclinic.com
- Email subject line: APPT DATE, First Initial. Last Name (ex: 07/02/23 T. Swartz
For patients booking in person:
- scan (give to reception)
Patient Financial Responsibility
Patients are responsible for paying any balances not covered by insurance within 15 days of receiving a billing statement.
Patients are responsible for understanding their insurance benefits, including coverage limits, co-pays, deductibles, and co-insurance.
Patients must promptly provide Elite Spine and Sports with any updates to their insurance information or payment method on file.
8. Cadence of Notification for Patients with a Balance
Post-Appointment In-Person Notification: After the completion of an appointment, the patient will be informed verbally if they have a balance on file and asked to make a payment. If they do not provide a new form of payment or create a payment plan, the method on file will be charged for the copay or full balance (no insurance) before the close of that business day.
Initial Billing Statement: Sent via email twice a month to patients with a balance.
For balances under $100, this message will include a notification that the payment method on file will be charged in full on the date on the statement if not paid within 15 days.
For balances over $100, this message will include a notification that the payment method on file will be charged for a minimum amount of $100 on the date on the statement if not paid in before that date.
Notification will include contact information to contact the Billing Manager to set up a payment plan, if needed.
First Reminder Notice: Sent via email if the balance is not paid in full within 15 days of the initial billing statement.
For balances under $100, this message will include a notification that the payment method on file was charged and include receipt.
For balances over $100, this message will include a notification that (1) There is still an outstanding balance (2) the payment method on file was charged for a minimum amount of $100 and (3) will include a receipt.
Notification will include contact information to contact the Billing Manager to set up a payment plan, if needed.
Second Reminder Notice: Sent via email if the balance remains unpaid 30 days after the initial notification.
For balances under $100, this message will include a notification that the payment method on file was charged and include receipt.
For balances over $100, this message will include a notification that (1) There is still an outstanding balance (2) the payment method on file was charged for a minimum amount of $100 and (3) will include a receipt.
Notification will include contact information to contact the Billing Manager to set up a payment plan, if needed.
Final Notice: Sent via mail if the balance is not paid within 45 days of the initial reminder. Failure to pay the balance within 60 days of the final notice may result in the account being sent to a collections agency.
9. Payment Plans
Elite Spine and Sports offers payment plans for patients who are unable to pay their balance in full.
Payment plans must be arranged with the Billing Manager after the first patient balance notification has been sent and before the second notification has been sent 15 days later and require a signed agreement detailing the payment terms.
Without a signed payment plan on file, the payment method on file will be charged at the completion of the next follow-up visit.
10. Contact Information
For questions regarding this policy or to discuss payment options, please contact Billing Manager at 503-625-0500 or info@elitespineandsportsclinic.com
Policy Updated 7/15/24
