Dear HMO member,
Your insurance company has certain requirements that both you and this office must fiollow in order for you to recieve the maximum benefits for which you pay, and for us to receive payment for these services provided.
- Our contract with your insurance company makes your family and/or primary care provider and requires that all of your nedical case be coordinated through and communicated through us.
- If you have a medical problem, you must see the Burtonsville Family Health nurse practitioner who will treat you to the best of his/her ability. If he/she feels that they are unable to treat the problem, they will write you a referral to a participating specialist.
- You must always have a referral from this office before you receive any health services from another provider (specialist).
- Any subsequent contacts with the specialist not provided for on your initial referral must be cleared by your primary care provider. In other words, even if the specialist tells you to return to his/her office, you must first ascertain if the original referral provided for this service, or if you must be evaluated again by your primary care provider.
- There may be some services that your plan does not cover. Should you choose such a service, you will be personally responsible for any charges incurred.
- We are under the understanding that you have chosen Burtonsville Family Health as your primary care provider (pcp), however if you have not, you will be financially responsible for the visit. It is the patient's responsibility to contact the insurance company and change your pcp before the date of service. If this has not been completed before the date of service, the insurance company may not pay for the visit. Therefore, the financial responsibility would become the patient's.
Failure to follow any of the above rules could result in expenses being denied by your health plan, or worse (cancellation of your contract). We ask for your cooperation in following the above rules and suggest that you read your member handbook for more information. Additionally, you can call your health insurance company for any clarification.
We have attempted to contact your carrier to verify coverage. If we have been unable to do so, we will provide services that you requested but you will be responsible for the charges in full should the insurance company deny your coverage for any reason.