An objective of University Surgical Associates (USA) is to provide you and your family the highest quality of care at a reasonable fee. This depends greatly on your understanding of our financial policy. We file insurance claim forms for most carriers on your behalf. We do this as a courtesy to our patients and are anxious to help you achieve the maximum allowable benefits from your insurer. With the advent of "managed care," it has become increasingly difficult for USA to secure payment for services and your active participation in the insurance claims process is necessary. Please keep in mind that your insurance policy is a contract between you and your insurance company. We sincerely appreciate the trust you've placed in the surgeons and staff of USA. If you have any questions regarding policy, please call us at (423) 265-6578.
Preauthorization and Verification
USA makes every effort to comply with your insurance company's requirements. Eligibility verification, benefits determination, referral/pre-certification, and medical necessity are examples of these requirements. Your insurance plan may approve a service but then refuse to pay. They may demand a refund up to three years after your service and you will assume responsibility. If you get a statement and don't know why, please call our office and speak to a financial counselor.
Medicare and Medicaid
These programs are regulated by state and federal laws that determine which services are covered, the amount to be paid and your portion of responsibility. You will be billed only for services that are not covered by your plan or for any copay, deductible or coinsurance. If you have supplemental insurance, please let our receptionist or financial counselor know.
If your health care needs are the result of a work-related injury, you are required to supply the name, address and telephone number of your adjuster, along with the claim number. Any services rendered must be approved by the claims adjuster. Failure to follow these guidelines may result in non-payment on your claim and you will be responsible for any balance.
If your health care needs are the result of an accident, please provide the following information to ensure your claim is handled in a timely manner: (1) Date and type of injury; (2) Auto accidents require any auto insurance information including contact name, claim number, address and telephone number.
Legitimate Insurance Companies
USA is generally contracted (participating providers) with most legitimate insurance companies. The insurance company pays based on a negotiated, discounted fee schedule. You are responsible for your copayment and deductible according to your plan. In most cases, we are obligated to accept these fees as payment in full. However, your insurance company may determine your service was not a covered benefit or "medically necessary." In that case, you will assume responsibility for payment for these services. Examples of these companies include: Blue Cross, John Deere, Cigna and Aetna.
Regional/National "PPO" Networks and Claims Re-pricing Companies
There are literally thousands of these companies, which are not licensed insurance companies. They attempt to price and discount our claims to levels that are often below Medicare and TennCare. As a result, we have decided to terminate many of our contracts with these unlicensed companies. Some are legitimate and we accept a negotiated fee from them. Unfortunately, it is often difficult for us, or you, to determine if these companies are going to be involved in processing your claim. We will make our best effort to notify you in advance if we suspect that one of these companies may try to get involved in re-pricing your claim. Examples of these companies include: Beechstreet, PHCS, First Health, PHP, CCN, Southcare, Coresource, Health One Alliance, One Health Plan, Unicare and Focus Healthcare.
All copays are collected at the time of service and you will assume responsibility for any outstanding balance. If needed, a USA financial counselor will be happy to assist you in arranging a suitable payment plan. If you are in need of financial aid, please contact (423) 265-6578.