Your insurance policy is a contract between you and the insurance company. Americare Kidney Institute works diligently to participate with most insurance companies that serve our local communities. A current patient information sheet with assignment of benefits must be filled out and signed.
We will require that this be updated annually or as needed. We will copy all insurance cards: front and back side. We will bill your insurance plan(s) for you, as long as you provide us the correct information. Please be aware that some, and perhaps all of the services provided may be non-covered services and/or not considered medically necessary under your health insurance plan. You, as the patient, are ultimately responsible for payment of all services provided by our facilities. All copayments are required at the time of service. If you have secondary and third insurance, we will bill it for you, as a courtesy, as long as you have provided us with the appropriate information.
REFERRAL FORMS: If you are covered by an insurance company that requires referrals, it is imperative for you to contact your Primary Care Physician (PCP) and have their office make a referral to us prior to your appointment. If your plan requires a referral to obtain your full benefits and you incur an out-of-pocket penalty by not supplying one, you will be responsible for the non-covered amounts connected to that visit.
MEDICAID PATIENTS: You are not responsible for any balances due after Medicaid has paid unless your Medicare plan has a “spend down.” In order to know that you have Medicaid, you must present your Medicaid Card at EVERY appointment.
SELF-PAY PATIENTS: If you are not covered by medical insurance, you will need to speak to the billing office by calling (440) 799-4224. It is imperative that you speak to a billing representative who may be able to offer you additional information including a minimum deposit for services provided during your visit. Help is available so you may be asked to complete financial forms to document qualification guidelines.
Financial Policy Acknowledgement — Please review, print, sign and bring this document with you to your first appointment.