Modern Family Medicine

Insurance, Fees and Payments

Fees & Payments:
We make every effort to decrease the cost of your medical care. Therefore, we request payment arrangements for all office services at the time they are rendered unless prior arrangements have been made. We accept debit and credit cards only for your convenience (no cash or checks). If we are a participating provider of your insurance company, we will bill them. Payment is the patient’s responsibility.

If we do not accept your insurance plan, we can provide an invoice for you to send to your insurance company, as an out-of-network provider. We will help in any way we can to assist you in handling claims and can set up payment plans.

According to our insurance contracts, we must collect by law all co-payments at the time of visit. Due to Medicare laws, these co-payments are non-refundable. We are unable to refund any costs once services are rendered.

If we are not contracted with your insurance plan or you do not have insurance: office visits range from $125 to $400 a visit depending on complexity. Diagnostics and lab fees are not included.

We are now offering a Direct Primary Care Package for patients who have opted out of the Affordable Care Act or have an insurance plan we are NOT contracted with. (If we are contracted with your insurance, we can not offer this plan).

For Patients who have opted out of the Affordable Care Act or have Out-of-Network Insurance plans:

Patient Annual Direct Primary Care Package:   please call for pricing

Includes:

    • 12 – medical office visits or medical acupuncture visits  –a year with the doctor including simple office procedures (some restrictions apply – value over $1500)
    • Quickie Sickie Appointments (we will try to accommodate same day or next day)
    • Routine Basic Lab* testing package including lab draw and handling fees (worth over $1300) (does not include STD testing)
    • Pap Smear for women (value $90) or
    • PSA testing for men (value $44)
    • EKG (value $65)
    • Spirometry (value $65)
    • Annual Flu Shot if desired  (value $25)
    • 12 – 15 minute Breathing Bar ™ sessions (value $180)
    • 25% off holistic classes
    • 10% off professional quality supplements
    • Complimentary 20 minute Self-Hypnosis sessions 
  • Patient portal access to email directly with physician
  • Discounted radiology studies with participating vendors
  • Discounted in-office lab testing if needed – (strep tests, pregnancy, Urinalysis and further lab testing)
  • Discounted injections
  • Discounted prescription resources
  • Assistance in scheduling with specialists for quicker appointments if needed (does not include payment to specialists, ancillary testing, outside office testing, injections, pharmaceuticals)

Holistic services can not be billed through insurance. Flexible or Health Savings Accounts may cover most services. Check with your individual plan first.

Medical Acupuncture is billed as a procedure visit in addition to a medical office visit. The medical portion of the visit is billed through insurance. If your insurance plan does not offer acupuncture as a benefit, the cost of an initial medical acupuncture treatment is $150. Subsequent treatments are $75 in addition to a medical office visit billed through insurance.

We also offer a Holistic Care Package!

Because the acupuncture procedure is being performed by a physician, the medical portion of the visit is billed to contracted insurance. If the patient does not have insurance or has an out of network plan, the office visit is also charged at $125 per session. Medicare patients must sign an Advanced Beneficiary Notice, as these services are not covered by Medicare.

Holistic Care Package

$720 annual fee – (must be paid in full and can not be refunded – does not include cost of medical office visit)

Includes:

12 – Medical Acupuncture or cupping sessions (worth $975)

12- 15 minute Breathing Bar ™ Sessions (worth $180)

25% off Holistic Classes

10% off Professional Quality Supplements

Complimentary Self-Hypnosis sessions

Insurance:
For medical visits, our office accepts a variety of insurance plans including Aetna, CIGNA, Medicare, BCBS, United Healthcare, Tricare, Multi-plan and many more. Please call our office to verify acceptance of your insurance carrier. We must verify your insurance prior to being seen for medical visits. If we do not accept your insurance, you can pay us directly the cost of the visit and we can provide you with the appropriate forms to submit to your carrier for reimbursement.

For holistic services, we are unable to bill most insurance but depending on your plan, you may be able to pay with your  Flexible Saving Accounts. Please check with your plan first.

Virtual visits are paid directly to the online service at the time of the scheduled visit.

Appointments:
Please call ahead to book your appointment time. We will try our best to accommodate same day or next day appointments. Please be sure to check-in with the front desk at least 30 minutes prior to your scheduled appointment time. This will help keep the patient flow and assist the providers in staying on schedule.

While you wait for your appointment, you may need to fill out necessary paperwork, or need insurance verified. You are also welcome to enjoy relaxing in our outdoor meditation atrium, meditate to one of our guided meditations, color one of our adult coloring pages, enjoy a refreshing aromatherapy session at our “Breathing BarTM” or relax with a hot pack steam treatment (both for nominal fees*).

 Every attempt is made to comply with insurance company’s requirements. Since policies and benefits differ among every type of insurance and the plans within them, we are unable to know the specifics of your policy. Insurance companies inform all participants that it is ultimately the patient’s responsibility to verify benefits and coverage information prior to having any services rendered. 

Gartenberg Family Medicine, PLLC dba Modern Family Medicine cannot guarantee the cost of services performed will be covered by your insurance. To limit the charges that you may be responsible for please ensure that we always have up to date information regarding your insurance coverage and any name/address/phone/employment changes.

FINANCIAL POLICY

Thank you for choosing Modern Family Medicine for your family’s health care needs. We are committed to providing you with exceptional quality medical care. We appreciate your adherence to our financial policy.

Except as indicated below, payment is required at the time service is provided. We accept VISA, MASTERCARD, AMERICAN EXPRESS, DEBIT CARDS only.

We DO NOT accept cash or checks.

  • Proof of Insurance – All patients must complete and update a Patient Information Form at each office visit. You must furnish valid and up-to-date proof of insurance and copy of your drivers license. If you provide false or expired insurance information, you will be responsible for the balance of the claim. Please notify us of any changes in your insurance coverage prior to time of service. Insurance denials at time of service will be automatically billed to you. Be familiar with your co-pay, deductible and co-insurance. Be prepared to pay the FULL amount at each visit. It is the patient’s responsibility to ensure that the providers are in-network providers prior to your first visit.
  • Co-payments and deductibles – All co-payments, current balances, deductibles, and co-insurance are due and payable PRIOR to services being rendered and are required by your insurance contract to be paid at each visit. Our billing department will bill you any additional amount not covered or credit overpayment to your account accordingly after your insurance pays their portion. If payment is not paid at the time of service, a $25 administration fee will be assessed.
  • Claim submission – We will submit your insurance claim and assist in any reasonable way. Your insurance company may request additional information from you. It is your responsibility to comply with their request in a timely manner. Please be aware that the balance of your claim is your responsibility whether or not your insurance company has paid.
  • Patient Balance Policy – After filing with your insurance company, we will send you a patient balance statement via mail or email. Payment in full is due upon receipt of this statement. If you have any questions or wish to dispute the balance, it is your responsibility to contact our billing office within 30 days of the date of the statement. Past due accounts are subject to $15.00 administrative fee per month and may be referred to a credit bureau or collection agency. If you are unable to pay the balance in full, you must contact our billing office to discuss a payment schedule. Any late fees already incurred on past due balances will be included.

  • Referrals – All referrals require evaluation in the office or a virtual visit with the provider.

  • New Orders – All new orders, new prescriptions, lab reviews require a face to face office visit (or virtual visit if appropriate).

  • Medication Refill Policy – Medications will be prescribed with more than enough refills until you are due for a follow up visit to reassess the medication. We DO NOT accept faxes from pharmacies. It is your responsibility to make a follow up appointment for medication refills before you run out.

  • Controlled Substance Policy – Please refer to our detailed office controlled substance policy. All controlled substances require an office visit, where a paper prescription will be hand signed by the provider. Controlled substances will only be prescribed for one month with no refills. We participate in the Arizona Prescription Monitoring Program. Patients must oblige to random drug screens.
  • Self-payment – We make every effort to keep self payment fees reasonable and on par with our contracted insurance rates.
  • Holistic services – the majority of holistic services are not covered by most insurances. Please check with your insurance company first. These services will not be billed to insurance unless proof of coverage is noted. Payment for these services are required at the time they are rendered.
  • Medical Acupuncture – Medical Acupuncture visits will incorporate a medical office visit plus a procedure visit.  The cost of the procedure is also required at the time of the visit. HSA or FSA cards can be used towards these services. All Medicare patients being treated with Medical Acupuncture or holistic services must sign an Advance Beneficiary Notice and pay for the procedure at the time of service.
  • Virtual Office Visits – Virtual office visits are available. You must have a good internet connection and camera on your computer. Virtual visit kits can be ordered for purchase for patients who live remotely or are homebound.

  • Well Visit/Problem Visit – Insurance companies distinguish a well visit as a routine maintenance visit including general physical exam and labwork which does not include addressing any other medical problems. A problem visit addresses the medical problems. If you are requesting a well visit and also discuss medical problems that require evaluation and/or treatment, you will be responsible for cost of the portion of the visit your insurance does not cover, depending on your individual plan.

  • Problem Focused Visits – In order to address each of your problems thoroughly and in a timely manner without creating extensive billing charges, we ask that you keep your complaints to no more than 3 problems per office visit. The provider may sometimes need to focus on a more critical problem, s/he finds that requires evaluation. So, please understand that we care about all of your problems but some diagnoses may require more immediate attention.

Insurance coverage generally does not include coverage for many administrative services such as, prescription refills, after hours medical consultation, requests of information, copies of medical records, etc. The following services may have an administrative service charge that will be directly billed to you. Payment is your responsibility. All administrative fees are required prior to scheduling future appointments.

  • Late for appointments – If you arrive more than 15 minutes late for your scheduled appointment, you may have to reschedule.
  • Missed appointments – It is your responsibility to remember your appointment, however, we understand that you may have to occasionally miss an appointment due to other obligations or emergencies. We require 24 hours notice of cancellation to avoid a $50 no show fee. Patients with more than 3 missed appointments, will be discharged from the practice.
  • Prescription authorization – We will honor prior authorization requests from patients. Patients are required to contact their insurance company to have them forward the prior authorization form to our office. If the prior authorization is addressed after an office visit, the patient will be charged $25 for completion of the prior authorization form. If an alternative medication is preferred, the patient needs to schedule an office visit to discuss with the provider.
  • Form Completion Policy – All forms requiring medical review and physician signature will be charged $35 for the first page and $15 each additional page. FMLA paperwork, disability, or other paperwork require an office visit.
  • Health Care Advice – for any medical advice not related to patient’s office visit, requiring additional research will be assessed an administrative fee of $75 per quarter hour.
  • Requests for Medical Records – All copies of medical records are charged according to Arizona state law. Please allow up to 15 days for these records. Expedited copies will be charged for an additional fee.
  • Return Check Policy – If a check is submitted as payment in the mail, there is a $45 charge for returned checks which will be added to your original balance. In addition, we may seek all additional legal remedies.
  • No Show/Same Day Cancellation Policy – Patients will be charged $50.00 fee for failure to show up for scheduled appointment and $25.00 fee for cancelled appointments with less than a 24 hour notice. Monday appointments must be cancelled by the Friday prior to the appointment. Payment must be received before scheduling the next office visit.