ACCEPTED INSURANCE PLANS
We regularly review and update our accepted insurance plans. Please contact your insurance carrier directly before your appointment to verify your coverage. You will be responsible for any expenses not covered by your insurance plan.
We will submit all claims and necessary supporting documentation with participating insurance carriers on behalf of our patients. Any studies or treatments will be pre-certified with the insurance provider prior to dispensation.
DEDUCTIBLES AND CO-PAYMENTS
Many insurance plans include provisions for deductibles and co-payments. The amount of each will be determined by your specific plan. Any co-payment required by your plan will be collected at the time of your visit. It is the patient’s responsibility to understand his or her specific insurance policy.
Our clinic offers some treatments that are not covered by insurance plans. Should we recommend these treatments to you, you will be notified of all out-of-pocket expenses prior to beginning treatment and asked to sign a “non-covered service waiver.” Payment for these services will be required in full before beginning treatment. Common non-covered treatments that we offer include platelet-rich plasma (PRP) injections and certain durable medical goods (such as braces).
If your insurance carrier requires referral prior to your visit or treatment, it is your responsibility to provide us with the name of your referring physician. If you do not have a referral prior to your visit, you may be responsible for the full payment for your office visit or procedure, or you may need to reschedule your appointment.
Workers’ compensation appointments must be scheduled by your case manager or worker’s compensation adjuster. Our practice cannot make an initial appointment directly with a patient. Case managers must provide us with complete workers’ compensation information in writing prior to scheduling an appointment.
It is your responsibility to provide our office with complete insurance information, as well as contact information for your case manager. Our office will only submit open claims on your behalf, unless we are made aware in advance that the claim will be denied.
Should your workers’ compensation claim be denied, we will bill your primary insurance carrier for the full amount of your visit and treatment. Any balance not covered by the workers’ compensation claim and primary insurance carrier will be the responsibility of the patient.
MOTOR VEHICLE ACCIDENT (MVA) AND LITIGATION CASES
Our clinic does not recognize MVA and litigation cases. Unless you have active health insurance coverage and we receive a letter of subrogation from your insurance company, you will be classified as a self-pay patient.
Should your health insurance carrier determine that your claim should be refunded due to third- party liability, you will be responsible for handling the bill through a litigation attorney. For no reason should you delay payment due to ongoing litigation. Payment of the bill is the responsibility of the individual who has received the treatment, not the individual who is being sued.
We consider patients who do not have insurance to be “self-pay” patients. As such, you will be required to pay a $300 deposit at the time of your visit. Payment must be made in cash, by credit card, or money order. Future visits, surgery, and treatment will require further pre-payment. Until payment is made, you will not be seen.
Out-of-pocket expenses are dependent on the level of your insurance coverage. After we have received final payment from your insurance carrier, you will be billed for any remaining patient responsibility balance, as indicated by your insurance carrier. You are responsible for any deductibles that have not been met.
If your insurance carrier does not have a contract with Cedar Valley Medical Specialists, P.C., you are considered an out-of-network patient. We will submit your claim to your insurance carrier, however, as an out-of-network patient, your out-of-pocket expenses may be higher than you would experience with an in-network provider.
Please note: Out-of-network patients may receive the claim check directly via mail. Should you receive such a claim check, you are responsible for signing and forwarding the check to our billing office.
HOSPITAL BILLS AND PHYSICIAN FEES
Hospital services provided by your primary care physician or other specialists such as anesthesiologists or consultants will be billed separately to either your insurance carrier or you. Please direct any questions regarding these bills to the hospital or surgery center where you underwent the procedure. Our office has no control over these charges.
Charges for your hospital stay are based on the length of your stay and the services and treatments that you received over that time. These specific charges will be itemized on your bill from the hospital. Please direct any questions regarding this bill directly to the hospital.
PRESCRIPTION REFILL POLICIES
We will only prescribe medications to current patients who have been seen within the past three months. If you require a long-term anti-inflammatory or other medication, we recommend that you contact your primary care physician.
We cannot call in narcotic pain medications. Refills of narcotic pain medications must be picked up at our office by you or a person appointed by you. No prescriptions will be dispensed without a photo ID.
No prescriptions will be dispensed:
- After 4:00 p.m. Monday-Thursday
- After 12:00 p.m. on Friday
- On weekends
Call our office for any refill requests. Please allow at least 48 hours for your prescription to be renewed.
Requesting Medical Records
- We encourage patients to access their medical records via the Patient Portal
- Mail or fax the form to: 2351 Hudson Road, Ste. 001, Cedar Falls, IA 50614 or 319-273-5925
- Expect a wait of approximately 10 business days for the fulfillment of any medical records requests. Records requests are processed in the order that they are received.
- If you have questions, please call: 319-273-5275
There is no charge for written medical reports. X-ray CDs will be provided upon payment of a $10 fee.
DISABILITY, FMLA, AND CLAIM FORMS
- The wait time for completion of forms is approximately 10 business days
- The fee for completion of forms is $10