Midwest Medical Specialists cares about the health and well-being of our patients. We understand that the lack of health insurance coverage may negatively affect the lives of our patients. If you are uninsured, have limited coverage/policy exclusions, have a plan that is out-of-network with our office, or would simply prefer to pay as self-pay rather than have your claim sent to insurance, there are several options available to you.
As a self-pay patient, you will be responsible for payment in full at the time of service. Because we strive to provide complete transparency to our patients to the best of our ability, we ask that you please familiarize yourself with our self-pay process prior to arriving at your appointment.
Time of Service Discount
The Time of Service discount is offered to patients that are uninsured, have limited coverage/policy exclusions, or are covered by a plan that is out-of-network with our office. The Time of Service discount provides you with a 50% reduction on most billed services (some exclusions and restrictions apply). Please contact the billing department to determine your eligibility for a Time of Service discount. Please note: we will request a copy of your insurance card for our records even if you elect to be seen as self-pay.
If any participating insurance is later identified by either yourself or one of our team members and is determined to have been active at the time of service, we may be able to submit your claim retroactively to insurance depending upon your plan’s filing guidelines. The Time of Service discount would be reversed, and full billed charges would be sent to your insurance company at that time for their review of services. Once the insurance has reviewed your claim and notified us that it has either processed or denied, a review of your account will be needed. Once you have received your explanation of benefits from your insurance company, you should then contact the Billing Department to conduct a review of your account for potential overpayment or adjustment needed at that time. Please note that this does not apply to patients that have signed a waiver for Restrictions on Uses and Disclosures of PHI.
We are not accepting new patients with Medicaid primary insurance, and Medicaid recipients cannot be seen as self-pay. If you purposely misrepresent yourself as a self-pay/uninsured patient and coverage is later discovered, we are not obligated to retroactively submit said claims to Medicaid.
Estimated Cost
If you are new to the practice or have not been seen by one of our providers for your current condition, it can be difficult to anticipate what services may occur beyond that of your office visit examination. Office visit costs vary greatly, and can range from $100 (the practice minimum) to $633 depending on the level and type of visit, and whether the Time of Service discount is applied.
During your office visit, your provider may determine based on your symptoms, physical exam and/or history that additional in-office services/procedures are needed to properly identify and treat your condition. While these services may be necessary for the provider to adequately determine diagnoses during your examination, they are considered a separate charge from the office visit itself.
You have the right to decline or defer additional in-office services if you are not comfortable moving forward with treatment, or if you would prefer to discuss cost with the billing office prior to giving your consent. Once you have provided verbal/written consent for a procedure/service and it has been performed, you are responsible for the cost of the service(s).
If you are an Uninsured or Self-Pay Patient, you have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services provided to you at your request. Requests for an estimate of expected charges should be directed to the billing office prior to scheduling such items or services.
At Your Visit
As a self-pay patient, you will be responsible for payment in full at time of service. Upon your arrival at our office, a $100 deposit will be collected from you during check-in. Once your visit with the provider is complete and you are preparing to check out, we will review the provider’s notes and verify any additional services/procedures that were performed. This review may take up to 10 minutes to complete while you wait; this is done to avoid the inconvenience of you receiving a statement later. Once the note has been reviewed, we will confirm the remaining balance due from you, which must then be paid in full. If your chart note is incomplete, we will apply your $100 deposit to the pending charges and provide you with a form explaining how the remaining balance will be billed to you.
If you are unable to pay the full amount requested at the time of check-out, you are responsible for contacting the billing office for payment arrangements within 24 hours to avoid forfeiting any Time of Service discount.
If your chart note was incomplete at the time of check-out, you must pay the remaining balance in full upon receipt of the first statement. If the account remains unpaid after 30 days, the Time of Service discount will be forfeited and the full charge amount will be due.
Patients with No Insurance, Limited Benefits or Out-of-Network Plans
The Time of Service discount is offered to patients that are uninsured, have limited coverage/policy exclusions, or are covered by a plan that is out-of-network with our office. The Time of Service discount provides you with a 50% reduction on most billed services (some exclusions and restrictions apply). Please contact the billing department to determine your eligibility for a Time of Service discount. Please note: we will request a copy of your insurance card for our records even if you elect to be seen as self-pay.
Patients with Medical Sharing Plans
If your share plan ID card lists a claims mailing address or electronic filing information on it for providers, our office will submit the claim to your plan on your behalf. If there is a copay listed on your plan, you will be required to pay this at the time of check-in. Once the claim is processed, you will receive a statement for any balance remaining after your plan has applied their network discount.
If your share plan card does not contain claim filing information or states that the patient must submit a bill directly to the plan, you will be considered a self-pay patient and will be expected to pay in full at the time of your visit. You may qualify for the Time of Service discount since there is no contracted network affiliated with your plan.
Patients with Active Participating Insurance
It is your choice as a patient if you do not wish to utilize your health insurance and instead pay out of pocket. However, because of our contracted agreements with participating insurance, we cannot offer the Time-of-Service discount to you. You will be required to pay for your services in full at the time of the appointment and will be asked to sign an acknowledgement that you are waiving your health benefit coverage for the date of service in question. Should you need help determining if we participate with your insurance, please contact the billing department. Please note: we will request a copy of your insurance card for our records even if you elect to be seen as self-pay.
Patients with Participating Insurance, unable to verify coverage/eligibility
If you elect to keep your appointment as scheduled, you will be considered a self-pay patient and must pay in full at the time of your visit. Due to our contracted agreements with many participating insurance plans, we will be unable to offer the Time of Service discount to you. You will be responsible for paying for your services in full at the time of the appointment.
After your visit, should your insurance be verified and determined to be active at the time services were provided, we may be able to submit your claim retroactively to insurance. It is your responsibility to supply the billing department with all pertinent information. Once the claim has been submitted and processed, any approved network discounts and/or insurance payments indicated on the explanation of benefits (EOB) would be posted to your claim. This may result in a possible credit balance on your account; you may contact billing regarding any potential overpayment due to you. If valid insurance information is not received prior to your plan's claim filing deadline, our office will be unable to submit a claim to your insurance company on your behalf (you will not receive your plan's contracted discount rate).
If insurance is never provided to us, or it is determined that there truly was no active coverage for the date of service in question, the Time-of-Service discount may be retroactively applied to your visit. It is your responsibility to contact the billing department to have a review of your account for potential discounts and overpayments.
Patients with Participating Insurance, photo identification not provided
In the effort to protect you and your insurance from fraudulent claims and to reduce errors when sending claims to your insurance, you will be asked to present valid photo identification to our office when checking in for an appointment. If you do not have valid Photo ID but elect to keep your appointment as scheduled, you will be considered a self-pay patient and must pay in full at the time of your visit. Due to our contracted agreements with many participating insurance plans, we will be unable to offer the Time of Service discount to you. You will be responsible for paying for your services in full at the time of the appointment.
If you are able to provide a valid form of identification after your visit and we have confirmed your eligibility with your participating insurance, we may be able to submit your claim retroactively to insurance. It is your responsibility to supply the billing department with all pertinent information. Once the claim has been submitted and processed, any approved network discounts and/or insurance payments indicated on the explanation of benefits (EOB) will be posted to your claim. This may result in a possible credit balance on your account; you may contact billing regarding any potential overpayment due to you. If valid photo ID is not received prior to your plan's claim filing deadline, our office will be unable to submit a claim to your insurance company on your behalf (you will not receive your plan's contracted discount rate).
If you are an Uninsured or Self-Pay Patient, you have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services provided to you at your request. Requests for an estimate of expected charges should be directed to the billing office prior to scheduling such items or services.
Please note that all services provided by our office, whether processed as self-pay or through insurance, are documented in your patient chart and are considered a part of your formal medical record.
