Independently Owned and Operated since 2004
Policies

15 Minute Early-Arrival Policy

To ensure that we have confirmed your insurance eligibility and all paperwork is up to date for an accurate visit, please plan to arrive 15 minutes prior to your appointment time. Please be aware that we may not be able to see you if you are late for your given appointment time. Completing paperwork ahead of time can be done by accessing forms through your patient portal and also found on the website under patient resources/ forms. Staff will be happy to assist with initial portal registration, you may also use the Patient Portal link in the upper right corner on the home page and use the ‘Sign Up’ button to create your own account.

Know Your Benefits

We encourage patients to take advantage of your full benefits with annual wellness exams, commercial or Medicare. Please be aware that it is your responsibility as a patient to know your benefits, including lab coverage and eligibility dates for services like physicals. Sensenbrenner Primary Care will do our best at connecting with the payors and knowing your last physical/ annual wellness visit date. However, it is the patient’s responsibility if your payor does not cover it.

Balances on Accounts

You understand and agree that ultimately you are responsible for any balance on your account, regardless of insurance status, and that non-payment of your account may result in the account being subject to collection agency or legal action. We will send you a statement monthly for any balance due on your account. Any patient who owes a balance on his or her account must be prepared to pay the balance due upon arrival at his or her next appointment. Failure to do so can result in cancellation of the scheduled appointment. If you are unable to pay the balance in full, you need to contact the office as soon as possible to make arrangements. Unless other arrangements are made with us in writing, the balance on your statement is due and payable when the statement is issued and is past due if not paid within thirty (30) days. If your account becomes past due, we will take the necessary steps to collect the debt up to and including legal action. If we must refer your account to an outside collection agency, small claims court or an attorney you agree to pay all costs associated with the legal collection of the debt. Failure to pay your account or to make satisfactory payment arrangements with us may result in termination of the physician-patient relationship with you. Once an account is transferred to collections, statement activity will cease. You will need to call the office to pay a collections balance.

Payment/Statement Options

In-network: Sensenbrenner Primary Care will file claims for in-network insurances. You are responsible for knowing your health insurance benefits, including deductibles, co-payments, coinsurance and if there are any exclusions to your policy. You are responsible for assuring that all referrals and/or authorizations are obtained for each visit. You will be expected to present a current copy of your insurance card(s) on every visit. For successful claim filing it is necessary that you provide us with accurate and current insurance and demographic information, an assignment of benefits and an authorization to release information. You certify that all information given is correct to the best of your knowledge and any changes to your information will be reported to Sensenbrenner Primary Care as soon as it is known by you. If you have insurance with a company or government agency with which we are contracted, any co-payments, co-insurance or deductibles required by your insurance company must be paid at the time of service. If you are unable to make your co-payment at the time of your scheduled appointment you may be asked to reschedule your appointment.

Out-of-network: If Sensenbrenner Primary Care is not contracted with your insurance company, payment in full for services rendered is due at the time of service. We will courtesy file a claim on your behalf and they will reimburse you directly. 

Self Pay/ No Insurance on File: A patient that does not have third party coverage from a health insurer, health care service plan, Medicare, or Medicaid and does not have an injury that is compensable for the purposes of workers’ compensation, automobile insurance, or other insurance as determined and documented by SPC is eligible for a discount under our Uninsured Self-Pay Prompt Payment Discount Policy. It does not apply to patients classified as underinsured (i.e., patients who present insurance coverage that is limited or otherwise does not adequately cover the patient’s charges) or patients who have health insurance whose out of pocket responsibility is derived from a non-covered service, co-pay, coinsurance, or deductible. A $50.00 uninsured self-pay pre-payment is made prior to or during appointment check-in (pre-payment applied to balance at check-out). Payment in full must be received on the date of service during check-out. SPC reserves the right to reverse the discount if a) a potential payer source is identified, b) the patient fails to pay in full at the time of service during check-out, c) the patient’s payment by check is returned by the bank (NSF check). Services provided by outside vendors (e.g., outside lab services) are not covered by this policy and questions related to discounts should be referred to the vendor directly.

Please do not call to make payments over the phone. You can pay your bill by mail or online.

ACH Check Conversion 

When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic funds transfer from your account or to process the payment as a check transaction. When we use information from your check to make an electronic funds transfer, funds may be withdrawn from your account as soon as the same day you make your payment, and you will not receive your check back from your financial institution.

Returned Checks

Sensenbrenner Primary Care will charge $25.00 for any returned checks. Payment in full (amount of check + $25.00 fee) is due ten (10) days after we contact you regarding the check. Payment on returned checks must be paid with cash, Visa or MasterCard only. We will not accept a check to cover the returned check. Repeat offenders will not be permitted to pay with checks. We also reserve the right to dismiss repeat offenders from the practice.

On-Call Service

Sensenbrenner Primary Care offers an on-call service for its patients the days and evenings the office is closed. This service is for established patients and is to be used for serious medical concerns only. The on-call service WILL NOT do the following: refill medications, phone in narcotic medications, or answer non-critical medical questions (i.e. check on referrals, discuss test results or medical conditions). Persons who abuse the on-call service with non-clinical inquiries may be subject to a charge.

Missed Appointments 

If you cannot keep your appointment, you must cancel 24 hours prior to your scheduled appointment. As a courtesy, we will attempt to contact you two business days prior to your appointment to remind you. However, it is ultimately your responsibility to keep up with your appointments. Missed appointments or appointments canceled with less than 24 hours’ notice will incur a $50.00 fee. You may be dismissed from the practice for excessive no-shows or cancels with less than 24 hours’ notice.

Formulary Benefits Data 

Formulary benefits data are maintained for health insurance providers by organizations known as Pharmacy Benefits Managers (PBM). PBM’s are third-party administrators of prescription drug programs whose primary responsibilities are processing and paying prescription drug claims. They also develop and maintain drug formularies, which are lists of dispensable drugs covered by a particular drug benefit plan.  Sensenbrenner Primary Care will access my pharmacy benefits data electronically through RxHub.

This allows us to:

1) Determine the pharmacy benefits and drug co-pays for a patient’s health plan

2) Check whether a prescribed medication is covered (in formulary) under a patient’s plan

3) Display therapeutic alternatives with preference rank (if available) within a drug class for non-formulary medications

4) Determine if a patient’s health plan allows electronic prescribing to mail-order pharmacies, and if so, e-prescribe to these pharmacies

5) Download a historic list of all medications prescribed for a patient by any provider.