Business Office - Billing

Main Phone: 303-440-3019

Hours:
Patient visitors: 8:30 AM - 4:30 PM
Phone calls: 8:30 AM - 4:30 PM

e-mail: business_office@bouldermedicalcenter.com

Please Note: E-mail with your Personal/Private Health Information does not go to a protected site. Please do not send your personal information, such as date of birth, or specific health information via e-mail. Boulder Medical Center cannot guarantee the privacy of such e-mails.

Contracted Insurance Carriers
What should I do before seeing my Doctor for the first time?
Medicare Frequently Asked Questions
Motor Vehicle Accidents
Worker's Compensation
May I set up a payment plan?
Credit Policy

Contracted Insurance Carriers:

Insurance carriers have a variety of plans. The HMO and PPO varieties both require contracts between the insurance company and the physician. The carrier agrees to pay the money directly to the physician in a timely fashion and recommend the physician to large groups of patients that may not otherwise know of the doctor. The physician in turn helps hold costs down by accepting a contracted rate for services and by handling the billing and many referral issues for the patient. Contracts are signed and expire often, so if you have an HMO or PPO check with your insurance carrier to make sure Boulder Medical Center is still contracted with your carrier. As of July 2007, the Boulder Medical Center is contracted with the following plans:

• Aetna EPO/PPO (Open Choice)POS/HMO/QPS/US Access
• Blue Cross & Blue Shield/PPO/Blue Card
• Cigna of Colorado HMO/PPO/POS/EPO
• Great West Health Care Plan (One Health Plan HMO/PPO)
• HMO Colorado/HMO/POS/Blue Advantage/HMO USA
• Humana Advantage and Choice Care Plans (excluding Medicare Advantage & PFFS plans)
• Medicare (Non Participating)
• PacifiCare PPO/HMO
• PPO USA/GEHA
• Private Health Care Systems (PHCS) PPO
• Rocky Mountain Health Plans –HMO PPO/HCO & Medicare HMO/CNIC ASO
• Sloans Lake Managed Care PPO - Cofinity
• Student Health Insurance - Aetna -CU Boulder students only
• United Healthcare Choice, Choice+/PPO/EPO and POS
• Vision Service Plan

The Boulder Medical Center does not participate with Champus/Tricare/Triwest, or any Medicare Advantage or PFFS plans.

If you have any questions about health insurance please contact our
Business Office at 303-440-3019 or Patient Services at 303-440-3015.

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What should I do before I see my doctor on my first visit?

• If you have medical insurance, know your policy. Do you need to get a referral from a primary care physician before the visit? Are the Boulder Medical Center physicians covered under your plan? Do you have a current insurance card or will you need to contact your employer's Human Resource Department?
• Please come at least 15 minutes before the scheduled appointment time to allow time for parking and to register.
• Stop at the front desk and let reception know you are a new patient.
• You will be asked to complete a patient registration form that asks for basic information:
  • Name
  • Date of Birth
  • Address
  • Phone numbers
  • Employer information
  • The name, address and phone number of your nearest relative or any other emergency contact
• Insurance billing information including
  • contracted insurance carrier's name, address, phone number
  • certificate number
  • group number
  • co-payment amounts that are due.
• You will be asked to read the credit policy on the back of the registration form and to sign the form.
• The registration personnel will ask for your insurance card so a copy may be made.
• If your insurance plan requires copay, you will be asked to pay at this time and given a receipt.
• Once your registration information is entered into our computer system, your medical chart will be assembled.
• You will be given directions to the proper physician's area, and sent on your way to meet your new doctor.
• If you are not covered by a contracted insurance, you will be considered "Private Pay" and be responsible for payment after your visit with the physician. Please be prepared to pay at least $75.00 of the bill that day. (Click payment plans to read about possible arrangements should your charges total more than $75.00.)

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Medicare Frequently Asked Questions

Are Boulder Medical Center physicians par providers (who accept assignment) or non-par providers (who do not accept assignment)?

Boulder Medical Center physicians and medical providers have chosen, as a group, to be non-par providers (do not accept assignment) based on their assessment of Boulder community needs and the healthcare market.

What is the difference between the terms "accepting assignment" and "not accepting assignment"?

The primary difference between these terms has to do with the fee that is charged, and how the bill is processed and paid. A physician who accepts assignment will charge a Medicare determined 'par' fee, and will send the bill directly to Medicare. Medicare then pays their portion of the bill directly to the physician. The physician then bills you (or your supplemental plan) directly for the remaining balance. Physicians who accept assignment are referred to as 'par providers', because they contract directly with Medicare.

A physician who does not accept assignment will charge a Medicare 'non-par' fee, which is an amount higher than the 'par' fee. The physician will send the claim directly to Medicare, but will also bill you for the entire amount. Physicians who do not accept assignment are referred to as 'non-par providers', because they do not contract directly with Medicare. Because of this, the payment of the Medicare portion is made directly to you. Therefore, you are responsible for paying the entire bill you receive from the provider, which includes both the Medicare portion and the patient responsibility portion.

When am I expected to pay my bill?

We ask that you pay for all office charges at the time the services are rendered. We will provide you with an office encounter form, which you can take to the cashier in the lobby to make your payment. A copy of this encounter form will be provided to you so you can bill your Medigap carrier once Medicare has paid you their share. If your bill exceeds $75.00, you may ask the cashier to request a meeting with an account representative to work out a payment plan on the amount exceeding $75.00, i.e. delay payment until Medicare had paid you.

What if Medicare denies a charge?

If you receive an explanation of benefits from Medicare that denies a charge, please send or bring a copy of the explanation of benefits to our business office. Include a note requesting that the charge be reviewed and why, and our office will review the charge. If we conclude that the charge should have been covered, we will appeal to Medicare on your behalf. If the charge is ultimately determined to be for a service that Medicare does not cover, then you will be responsible for the charge. Medicare provides limited benefits for routine exams and any lab services associated with such an exam. If you have questions concerning this, please contact Medicare.

Why are some of my claims paid directly to Boulder Medical Center?

Medicare requires that every provider process certain services as 'assigned', regardless of whether the provider is non-participating. Examples are lab charges, ambulatory surgical unit room fees and charges for Non-physician providers when they see a new patient for a new medical problem. You will be billed for coinsurance (the portion of the bill that Medicare does not pay) for any ambulatory surgery unit room fees and Non-physician provider charges incurred.

Why doesn't the Boulder Medical Center file claims with my secondary insurance?

As non-par providers who do not contract directly with Medicare, our physicians do not receive payments or explanations of benefit information from Medicare. Instead, Medicare sends the payment and the explanations directly to you. Medicare will not furnish the non-par physicians with explanation of benefit information. Therefore, you are responsible for filing with any secondary insurance carrier in what is the most timely and effective manner.
NOTE: Per Medicare, automatic crossover of claims to your secondary carrier is determined on an individual basis. To pursue this, you should contact your secondary/supplemental carrier to see if this option is available. If your supplemental carrier has the computer capability, a crossover will be initiated. Many of the BCBS and AARP plans will automatically crossover, but you should still contact Medicare to make sure they are set up.

Is there somewhere I can find help with filing my secondary claims?

Yes, there are organizations established to assist you with all aspects of handling your medical bills. You can find out where these organizations are by contacting the Division of Insurance at 303-443-1933.

Where can I get help?

The National Medicare help line is 1-800-633-4227.
The Boulder County Medicare Ombudsman office line is 303-441-1706.

Where can I find more information?

The official U.S. Government web site is http://www.medicare.gov/. It contains the latest facts and information concerning Medicare coverage.

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Colorado is a "Tort" state. How does billing work with Motor Vehicle Accidents?

Option 1: PIP/No Fault Insurance Purchased By 07/01/2003.

• Personal protection insurance or PIP pays for your medical expenses and losses. It also covers family members who are passengers in your vehicle.
• The patient would get PIP benefits under their insurance policy, even if the treatment occurs after July 1, 2003. The PIP carrier is bound to uphold the insurance contract in effect on the date of the accident, regardless of the new statute. The right to PIP benefits would continue for 10 years from the date of the accident.

Option 2: Colorado Tort“pure tort” policy purchased after 07/01/03.

• Medical Payment coverage is purchased under your own auto insurance policy
• MEDPAY” Medical Payment Coverage is designed to cover the medical costs no matter who was “at fault” in an auto accident.

Option 3: Health Insurance Coverage.

• For those who are injured after July 1, 2003, once they have exhausted their “MEDPAY”, “PIP” or don’t have “MEDPAY” under their auto insurance.
• Billings under health insurance will be handled exactly the same way as billings for non-auto related treatment.

Option 4: NO PIP coverage, No Torte coverage and No Health Insurance Coverage.

• The charges will be the patient’s responsibility to pay. Payment in full is expected at the time of service. If full payment cannot be made, you will need to contact the Patient Accounts department to set up a formal authorized payment plan.

General Information about Motor Vehicle Claims:

• Insurance claims will be filed to the insurance of the auto driver for auto versus pedestrian or bicycle accidents.
• Claims will be filed to the patient's auto insurance for the passenger of a motorcycle accident.
• Drivers of motorcycles involved in an accident must file their own insurance claims. As soon as possible after the accident, inform your auto insurance so a file can be opened and a claim number assigned.
• Bring the insurance's name, address, and phone number, name of the policyholder, name of the claim's adjuster and claim number to your first doctor's appointment. If you do not have this information at the appointment, ask for a MVA Notification form that you can take home and complete.
• Bills will remain the patient's responsibility until all of the information is received.

We will attempt to bill the auto insurance carrier for 120 days. If they do not respond or if they deny the charges, the balance will become the responsibility of the patient.

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How does billing work for Worker's Compensation claims?

If you are being treated for an injury that is the result of an accident that occurred while at work, this might be considered a Worker's Compensation issue. Be sure you notify your employer of the accident and ask for the proper insurance information.

• Please notify the receptionist this may be a Worker's Compensation claim when you are scheduling the appointment.
  • If you forget, please tell the receptionist when you arrive for the visit.
• Please bring the name and billing information of your employer's Worker's Compensation insurance to the visit.
  • If this isn't available, bring the name and phone number of a contact at your place of employment that can provide this information.
• A special form will need to be completed at each visit that is related to the Worker's Compensation injury.
  • You will complete part of the form, the physician will complete part, and then it will be sent to the Business Office.
  • The Business Office will set up the billing with your employer and the insurance company, and also forward claims as well as the physician's report for each visit.
• The Worker's Compensation insurance company will send payment directly to Boulder Medical Center.
• The patient will be responsible for payment if:
  • The employer or Worker's Compensation carrier denies coverage for the injury.
  • The Worker's Compensation form is not signed or has incorrect or incomplete information.
  • The Business Office is unable to obtain all insurance billing information.
  • A court order is given stating charges are patient responsibility due to a settlement

Please call 303-440-3019 and ask for the Business Office Representative that is responsible for Worker's Compensation claims.

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May I set up a payment plan for my account balance?

We would appreciate payment in full on the date of service for balances $75.00 and under. We do understand that some higher balances may require a little more time to pay. The Boulder Medical Center Patient Accounts department will be happy to set up a formal authorized payment plan for your balance. We do ask that you call or visit us as soon as you know you will need extra time to pay.

What can you expect when you talk to a Patient Accounts Representative?

• The representative will look at your account, the balance, how old the balance is, and determine how much time that you can be given. The longest time extended is 5 months, but only if you have called us when you receive your first statement.
• You will be asked to make your payment on or before a specific date. You can pick the date you would like for your "due date" as long as it is on or before the 25th of the month.
• You will be informed that the payment plan is only for the balance on the date you set up the plan. Any new charges acquired after the payment plan is established will be due at the time of service or within 30 days of receiving a statement showing the new charges. They can not be added into the payment plan.
• Once the payment plan is set up, you will be sent a letter that outlines the terms the representative discussed with you. It will also contain due dates and the scheduled payment amount.
• You will receive monthly billing statements until the balance is paid in full. The statement will note the scheduled payment as a reminder.
• Defaulting on a payment plan (not making the agreed upon payment by the scheduled date) may jeopardize your future relationship with Boulder Medical Center. The balance on the account may be forwarded to a third party for collection.

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BOULDER MEDICAL CENTER PAYMENT POLICY
for New and Established Patients

CHARGES AND PAYMENTS
We ask all of our patients to pay for their care at the time services are rendered. Payment may be made with cash, check, money order or credit card. For your convenience, we accept Visa, MasterCard, American Express and Discover.

We realize that illness and injury can sometimes cause unforeseen hardship on you and your family, therefore, if your charges at the time of service exceed $75.00, we only require payment of $75.00 and you will have 30 days from your statement to pay the balance in full. This will enable you to file your claim to your insurance carrier.

Insurance claim forms and a copy of your charges will be provided by your doctor, the lab department and/or the x-ray department at the time of service. If you have not been provided with these items at the end of your visit, please request them before you leave the area.

If you belong to a health insurance plan that our office does bill directly, you may be expected to pay all deductibles, coinsurance or co-payments, and any non-covered benefits at the time services are rendered. Managed care plan co-pays must be made at the time of service in order to be seen.

In the event that your account is assigned to a collection agency, all members of your account may be in jeopardy of losing the right to receive future services at BMC. Bankruptcy may also jeopardize the right to future services. In the event of divorce, separation or custodial cases, the guardian or parent bringing the dependent to the office will be held financially responsible. No one will be added or deleted from an account unless agreed upon by all parties. When a child reaches 18 years of age our office will put the child on his or her own account.

In the event your account is assigned to a collection agency or referred to an attorney not a salaried employee of Boulder Medical Center for enforcement of this agreement, you agree to pay reasonable attorney's fees.

STATEMENTS
An itemized statement will be mailed to you monthly if there is an outstanding balance due. If you belong to a managed care plan, a statement will be sent only if there is a balance due by you. The balance on your account is due upon receipt of the statement. There will be $4.00 in monthly re-billing fees added for past due statements. If you remit by a check which is later dishonored by your bank for any reason, a $20.00 check charge will be added to your account.

INSURANCE PAYMENTS
If you have insurance in which BMC is not a participating provider (i.e., indemnity insurance), it is your responsibility to pay for the charges at the time of service and to file the proper claim forms and to collect a reimbursement payment directly from your insurance company. If we file your claim, you give us permission to release confidential information to your insurance company.

You are responsible for informing us of all your insurance coverage. All disputed or pended claims will immediately become your financial responsibility. All pregnant patients must contact the billing office prior to their initial obstetrical consultation.

PATIENT WITH MANAGED CARE PLANS
Our physicians have agreed to manage your health care. You must adhere to your plan's specific policies and procedures.

Your plan requires that we evaluate and initiate treatment for each new or old health problem. At times, it may be necessary to consult with another physician. If this action is appropriate, your provider will arrange the proper referral. At no time will we approve retroactive referrals. Referrals are your responsibility to obtain prior to going to a specialist. If you have an emergency, our on-call doctor will respond to your call 24 hours a day and direct your care. Emergency room care requires preauthorization by our office.

As a managed care member, we request that you bring your current insurance card with you at the time of service. This will assist us in determining whether payment is due at that time or if we may bill your plan directly.

MEDICARE
As a Medicare beneficiary, you are required to pay at the time of service for all charges. Our office does not accept assignment from Medicare. We will submit your bill directly to Medicare. You will receive an explanation of benefits from Medicare, along with their payment. You are responsible for filing appropriate forms with any supplemental insurance. A copy of our office encounter form will be provided to you so you can bill your Medigap carrier after Medicare has paid you its share.

RELEASE OF RECORDS
I authorize the release of any medical, psychiatric, drug or alcohol information necessary to process Boulder Medical Center insurance claims. I understand that copies of my medical records will be sent to process insurance claims.

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