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Policies & Insurance

Sensenbrenner Policies

15 Minute Early Arrival

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. Prior to a scheduled appointment, patients will receive a text or email link to complete online forms.  If not received, patients will be able to complete in office questionnaires using an iPad, please arrive 15 minutes early. 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.

Payment/Statement Options

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.

Balances on Accounts

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 $100.00 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 Services

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.

Medication Policy

Sensenbrenner Primary Care participates with electronic prescribing directly to your mail order and local pharmacies.  Our goal is to assist our patients with prescription requests in an efficient and timely manner.  Due to the volume of prescription requests, we have created the following guidelines to help meet these goals:

  1. It is the patient’s responsibility to notify the office in a timely manner when refills are necessary.  Approval of your refill may take up to three (3) business days, so do not wait to call.  If you use a mail order pharmacy, please contact us fourteen (14) days before your medication is due to run out.
  2. Medication refills will only be addressed during regular office hours (Monday – Thursday, 7:00am – 4:30pm and Friday’s 7:00am – 10:45am). Please notify your provider on the next business day if you find yourself out of medication after hours.  No prescriptions will be refilled on Saturday, Sunday or Holidays.
  3. Keep in mind, anything received 2 hours before closing may not be addressed until the next business day.
  4. Prescription refills require close monitoring by your provider to ensure its safety and effectiveness. Your provider will prescribe the appropriate number of prescription refills to last until your next scheduled appointment. Generally, when you are down to zero refills, it is time to schedule a follow up appointment.  We prefer you request any refills of your medications at the beginning of your office visit.
  5. Patients requesting new prescriptions or antibiotics must be seen for an appointment. They are not prescribed over the phone because it generally requires an office visit.
  6. Refills can only be authorized on medication prescribed by providers from our office. We will not refill medications prescribed by other providers.
  7. Some medications require prior authorization. Depending on your insurance, this process may involve several steps by both your pharmacy and your provider.  The providers and pharmacies are familiar with this process and will handle the prior authorization as quickly as possible.  Only your pharmacy is notified of the approval status.  Neither the pharmacy nor the provider can guarantee that your insurance company will approve the medication.  Please check with your pharmacy or your insurance company for updates.
  8. It is important to keep your scheduled appointment to ensure that you receive timely refills. Repeated no shows or cancellations will result in a denial of refills and possibly ds
  9. If you have any questions regarding medications, please discuss these during your appointment. This avoids several phone calls to the Clinic over a short period of time and ensures efficiency. If for any reason you feel your medication needs to be adjusted or changed, please contact us immediately.
  10. Our goal is to reserve time for quality care, including responding to calls and the portal. Please note, we will not be able to respond to multiple requests for prescriptions requested outside of a visit. Refill requests through the portal and phone are responded to within 48 hours. If anything urgent in nature, please call the office directly to allow us to address immediately as indicated.

Our providers participate in the North Carolina Prescription monitoring program.

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.

Insurance Options

Medicare
  • Traditional Medicare (Part B)
  • United Healthcare Medicare (HMO, PPO, PFFS)
  • Humana Medicare (HMO, POS, PPO, PFFS)
Commercial Insurance
  • Aetna
  • Cigna / Great West
  • First Health / Coventry
  • HealthGram
  • Humana / ChoiceCare
  • Medcost
  • Partners Direct Health
  • United Healthcare (HMO, POS, PPO) (not participating with UHC Community)
BCBS Participation
North Carolina
  • BCBS NC Blue Advantage
  • BCBS NC Blue Care
  • BCBS NC Blue Classic
  • BCBS NC Blue Options
  • BCBS NC Blue Select
  • BCBS NC State Employees Health Plan
BlueCard (out of state)

Use the website below to see if we are a network provider using the alpha prefix from your BCBS card. Be sure to enter our zip code, 28277 and the alpha prefix from your card for accurate results!!

https://www.bcbs.com/find-a-doctor

  • BlueCard PPO Basic
  • BlueCard PPO/EPO
  • BlueCard Traditional
  • Federal Employees
https://www.bcbs.com/find-a-doctor
NON-PAR (not participating/not in network) COURTESY FILING

Non-par refers to insurance companies (payors) or plans that we do not have a contract with and are not participating with. If you choose to see us out of network, we will collect your balance in full and courtesy file an out of network claim to your insurance on your behalf. Understand that your benefits level will be reduced if there are any benefits at all. Please refer to your plan documents or contact the customer service number on the back of your card with specific questions regarding how your claim might be processed. A $50.00 pre-payment is made prior to or during appointment check-in (pre-payment applied to balance at check-out). The balance remaining is collected at check-out and the claim is filed to your insurance on your behalf with an indicator to the payor to reimburse you directly. The following are plans we do not participate in for 2022. This list is not exhaustive.

  • BCBS NC Blue Value
  • BCBS NC Blue Local
  • BCBS NC Blue Home
  • BCBS NC Blue HPN (High Performance Network)
  • BCBS SC Blue Essentials
  • Bright Health
  • HCSM (Health Care Sharing Ministries)
  • PHCS/Multiplan
  • Tricare (except Tricare Prime)
  • VBP (Value Based Plans)

We cannot courtesy file Medicaid, UHC Community (Medicaid), or Tricare Prime.

SELF-PAY (no insurance)

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 $100.00 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.

8821 Blakeney Professional Drive
Charlotte, NC 28277
Ph: (704) 887-1101
Fx: (704) 887-1102

© Copyright 2022 Sensenbrenner Primary Care

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In observance of the Thanksgiving holiday, Sensenbrenner Primary Care will be closed Thursday and Friday, Nov 24th & 25th. See you all again on Monday, Nov 28th!

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