We expect payment at the time of your visit unless special arrangements have
been made prior to your visit. We will file for you all surgical, and fracture
management fees. In other cases, we will give you the necessary information
to file your claim. All patients should bring their complete insurance information
and insurance card on the first visit. You are responsible for all charges.
Any questions or complaints regarding your coverage should be directed to your
insurance company. The following additional information may be helpful.
We are a participating Medicare provider which means we accept Medicare patients
and what Medicare pays, and any secondary insurance you may have. If you are
currently working and have Medicare, and private insurance, then Medicare may
be the secondary payer after your yearly deductable has been met. We file all
Medicare claims and secondary insurance.
You must bring your current Medicaid card with you on your first visit, and on
the first of each month you are seen. Medicaid patients are funded by a govern-
ment program. All claim forms are submitted by our office. No payment is required
of Medicaid patients unless you have used all the visits allowed then you are
responsible for your bill.
Workers compensation must be approved prior to being seen. The appointment
must be made by either your employer or the insurance carrier for workmens comp.
You will be required to fill out a job injury identification sheet. We file
all claims with the South Carolina Industrial Comission. At the conclusion of
your treatment or when you have reached maximum medical improvement you will
be rated according to the percentage of permanent impairment that you have for
the specific job related injury. Other corplaints, and/or injuries not related
to the original injury will be paid by the patient, and this should be paid at
the time of the visit. No payment is required on Workers Compensation patients. Refiling of claims and payments on workers compensation patients previously filed as non workers compensation is a lengthy process requiring considerable staff time and effort. Our staff have many other important clinical responsibilities that will take priority. You are encouraged to seek approval prior to your office visit if your injury is work related.
You must bring your private insurance card with you. The amount of payment of
surgical fees or fracture fees by your insurance company depends on the quality
of insurance you buy. Our fees are consistent with national averages. You are
responsible for the payment in full regardless of any insurance company's arbitrary
determination of usual and customary fees.
MCCAIN ORTHOPAEDIC CENTER
MANAGED CARE, ie, HMO's, AND PPO's are increasing in market share in this area.
As a member of a managed care plan you have certain responsibilities. You must
always bring your membership card with you. We are currently enrolled in the
following managed care plans.
- BCBS PPO
- UNITED HEALTH CARE
- AETNA PPO
- BC/BS STATE HEALTH PLAN
- CIGNA PPO ONLY
- CARE IMPROVEMENT PLUS
- PLANNED ADMINISTRATORS -PAI
- COMPANION-BLUE CHOICE
- TRICARE STANDARD
- WORKERS COMPENSATION HEALTH PLANS
- FEDERAL BCBS
Each plan specifies covered and non-covered services. You are responsible for
your co-payment and deductable at time of visit. Your copay will appear as a separate
charge on your encounter form. Other charges are discounted to your insurance company.
EOB will omit the copay charge as it is paid at the time of service by the patient to the practice. The insurance company is not responsible for copay. Many diagnostic studies, and
most durable medical equipment, and physical or occupational therapy require
pre-approval. Second opinions are required for some surgical procedures. Patients
may have restrictions on which hospital they may go to, and who they receive
second opinions from.
SELF PAY PATIENTS
These patients must bring funds to pay for their visit and x-rays. A payment
plan may be possible in unusual circumstances if prior arrangements have been
Though we do not encourage referrals from attorneys some of our patients have
multiple or single injuries where liability is a factor. A letter of protection
and a lien against the judgement and patients authorization form must be completed
prior to sending copies of medical records for use by the attorney. A fee is
charged for duplication of medical records.
GENERAL COMMENTS ABOUT ORTHOPAEDICS
A fracture management fee covers the initial diagnosis of the fracture and the
management, operative or non operative, until completion of healing. This includes
the management of any complication. This does not include additional x-rays
or additional casts. The decision making in fracture management is complex and
requires years of training. This fee covers office visits up to 90 days in most
cases. X-ray, injections, and cast application are separate charges. Surgical
fees are similar and include a 90 day follow-up in most cases. Cognitive skills
brought to bear on a particular situation may not have a clear link to the. time
involved.Past due accounts are turned over to a collection agency unless there are extenuating circumstances. Those accounts that abuse the system are taken to small claims
Richard S. Mccain, M. D.