Frequently Asked Questions
Yes, for any individual over 18 who wishes to designate someone else as their financial guarantor, the individual who will be responsible for the bills is required to come with the patient at the first visit. This could be arranged prior to the visit if the guarantor cannot come at the time of the visit. The financial guarantor will need to sign some paper work and the patient will need to sign releases to communicate regarding his/her private health and financial information.
No. It is the responsibility of the parent that brings the child for treatment to pay all co-pays, deductibles, or co-insurance at the time of service. The parent must then seek reimbursement from the other parent. We will supply receipts or other information necessary to facilitate this reimbursement, but we cannot become involved in the transaction.
Coordination of Benefits is when the insurance company needs to verify that the patient has either 1) only that insurance or 2) if the patient is covered by any other insurance, which is primary. Often insurance will ask for this information when the patient is a child or the patient has had other insurance in the past. It is not uncommon for an insurance company to ask for this information every year. Sometimes it is a delay tactic for paying your claims and they do not respond immediately to your call or website answer. Please get the name of the insurance representative, date, and time of your conversation or a reference # for your conversation/contact. This can be very helpful when they continue to hold processing of your claims.
Not necessarily. (It means you must be very well informed how your particular policy pre-existing clause is written.) The state of Texas dictates that if you have had insurance prior to your current insurance plan, and that you did not lapse in coverage for more than 63 days, you may have the ability to have your pre-existing clause waived. In order to do this, you will need to call your previous insurance company and ask for a Certificate of Prior Coverage. Once you have received this letter, you can submit it to your current insurance plan to negate this clause, in most cases. You should also supply our billing office with a copy in case we have to refile claims on your behalf and they don’t connect your response to the reprocessing of your claims. If you have not had previous insurance or it lapsed for more than 63 days, it is still possible to have claims paid by your insurance company. For any new condition that has arisen after your effective date, you will most likely need to fill out information from the insurance company regarding the condition. We will work with you and provide as much help as possible in this task.
Unfortunately, due to the legality of payment with Out of Network providers, we cannot file Tricare claims for you at this time. However, a reimbursement form can be found online. In order to be reimbursed from Tricare, you will need to fill out this form and submit your receipt of payment from us. The needed paperwork can be requested at any time from a member of the Billing/Collection staff or at the time of your check-out.
CPENT tried this policy and found it to be problematic in many scenarios for patients and us as well. We have now established the policy that allows patients the option of making a payment in advance which can be applied to future visits.
Sleep studies are billed as two components, much like radiology. The first component is to perform the test itself. This is the bill you will receive from the third-party location that performed the study. The second component is the physician charge for interpretation of the test. This second component is vital as the physician must review the test results for diagnosis and future treatment. You are not present for this portion of the service, but your insurance may apply a copay or deductible and coinsurance.
Due to HIPAA regulations, every patient is required to specifically designate by name and relationship any person that we may share his/her information. This includes appointments, billing, and protected health information. Even spouses and parents are covered by this requirement. Your husband would have to sign a release for CPENT staff to be able to answer your questions.