Nowadays more and more physicians are choosing to no longer deal with insurance companies and are requiring patients to pay for Services at the time Services are Rendered.
How can a patient who has paid for their office visit up front possibly get paid back for some or all of that money from their health insurance company? A patient can Submit their own Claim for a medical services rendered by a healthcare provider to their insurance company using a Self-Submittal Claim Form that is completed and signed by their physician.
As a courtesy to a patient in good standing at Youthful Endeavors, Dr. Hetz, upon written request from that patient, will help prepare a Self-Submitted-by-the-Patient Insurance Claim, SSPIC, Form for a previous rendered non-cosmetic related medical Service. However, a Self-Submitted-by-the-Patient Insurance Claim Form will not be provided for some Services, at the sole discretion of Dr. Hetz, nor for any Service whose Date of Service was provided 3 or more months ago.
These SSPIC Forms may contain one or more CPT office or procedure code(s) and one or more ICD-10 diagnostic codes, but there is no implied nor stated guarantee being made by Dr. Hetz or any staff member that any offered up codes will be accepted by or usable by the patient’s chosen insurance company. These SSPIC Forms are on Youthful Endeavors Aesthetics-Women’s Healthcare Associates, Ltd’s Letterhead and contain Dr. Hetz’ Wisconsin Medical license number and his National Practitioner’s ID number. The dollar amount for any specific CPT code will be populated with our standard prevailing fees for Services Rendered we consistently use and which are increased-changed once or twice each year to try to keep up with the yearly cost of living percentage increases.
Patients have the sole responsibility to send, by snail mail, email, and/or fax these SSPIC Forms into their insurance company’s Claims Department and to follow their insurance company’s handling and processing to its full completion.
When submitting a Self-Submitted-by-the-Patient Insurance Claims Form it is recommended, and expected, that the patient supply their insurance company a copy of their Receipt for Services Rendered that Dr. Hetz’s office staff supplied him/her at checkout on the date & time that the Service(s) was/were Rendered. This Receipt or Invoice shows what amount the patient paid for each Service, though there may be times where the amount the patient paid was a Discounted-for-Cash-payment-at-the-time-of-Service and thus the dollar amount shown on the Receipt/Invoice will be less than the standard & prevailing fee next to the CPT code on the SSPIC Form.
These SSPIC are simply a helpful-to-the-patient method to assist him/her to be considered for being paid back some dollars by his /her insurance company, but by no means is there any guarantee being made by anyone at Youthful Endeavors or by Dr. Hetz that the SSPIC Forms or the information that the Form was populated will be accepted by or covered by, or paid toward by their insurance company. Any dollar amount, if any, that an insurance may provide payment for or choose not to provide payment will be according to your insurance company’s policy fine print language and their interpretation of that fine print language. These SSPIC Forms will hopefully help allow the insurance company to determine if the Services Rendered by us at Youthful Endeavors to accept the submitted CPT codes with the adjacent ICD-10 codes as a covered medical care expense.
It should be expected that any level of insurance payment will be according to the fact that Dr. Hetz is an out-of-network Healthcare provider. The patient’s insurance company will unilaterally determine what Service or office visit charge will be rejected or not accepted as well as which part of the Service charge will go toward the patient’s Co-pay and what dollar amount goes toward the patient’s yearly out-of-network deductible or in-network deductible. The patient’s insurance company will determine what dollar amount of the SSPIC Form’s listed fee, if any, will be allowed as their usual and customary fee or the accepted-by-them fee that they will make their own calculations off of.
Once the insurance company finds all their ways to cancel or reject the dollar amounts provided on the SSPIC Forms they will decide what dollar amount they will or will not distribute to the patient, usually via a check and mailed, to the patient, not to the provider, Dr. Hetz, who provided the Service. Because the patient paid for the Services Rendered at the time of his/her visit, the patient is not expected to pay this office any additional money for that particular Service listed on the SSPIC Form, even if the Insurance company designates on the Estimated Of Benefits, EOB, print out that the patient is responsible for paying the Co-pay and/or a co-insurance amount and/or deductible amount.