In-Network Insurances:

Aetna

Aetna Medicare **

Aflac

Blue Cross Blue Shield*

Blue Cross Blue Advantage**

Champus

Cigna Commercial

Cigna Healthsprings **

Coventry

Freedom Life

Fox Everett

Golden Rule

GEHA

Health Choice

Humana**

Medicare**

Medicare Railroad**

Medi-Share

Mutual of Omaha

OptiMed

Optum Health

Tricare

Tricare Prime**

UMR

UMWA**

United Healthcare

United Healthcare Medicare**

Viva

 


 

Please note, these are the insurance companies we are currently in network with and may file claims to.    New patient applicants, holding these insurances, may still be declined as we may not be able to accept all applicants.

 

*At this time, new applicants with Blue Cross Blue Shield Policies beginning with: BEG or PGX may not be approved

 

**At this time, we are only filing to these insurances held by our current patients (New applicants with these insurances may not be approved)

 

Please contact our billing office if your insurance company is not listed.

 


Financial and Office Policies

Insurance:

You must bring your insurance card(s) to every visit and inform us of any changes as they occur. 

NorthRiver Primary Care Associates participates with various insurance companies. We will be happy to assist you, but it is the patient’s responsibility to know your insurance benefits, co-pays, deductibles and whether our physician is in network with your insurance policy(ies). Most insurances will not pay for everything. If a service is non-covered, the fees will become the responsibility of the patient or guarantor. All co-pays, deductibles or non-covered charges are due at the time of service regardless of who brings the patient in for his/her visit. We gladly accept Cash, Check, Visa, MasterCard, Discover and American Express as forms of payment. There is a 3.5% processing fee added to all credit transactions.

 

Private Pay:

If you are currently uninsured, NorthRiver Primary Care Associates requires an initial payment of $100.00, due on the date of service, that will be put towards the charges for your visit. You will be billed for any remaining balance of services rendered.

 

Billing Policy:

As a courtesy, we will gladly file your office visit claim to your insurance company. Once your insurance has paid, any patient balances remaining will be billed to the patient or responsible party. If you are unable to make your payment in full, we ask that you contact our billing office to discuss a payment plan. If your balance remains unpaid for 90 days we may, at our discretion, turn your account over to an outside collection agency. You will be responsible for the fees assessed by the collection agency. This outstanding debt may also be listed with local, regional, or national credit-reporting agencies and may have a negative effect on the granting of future credit.

All lab work sent to one of our reference labs for testing, will be billed separately by the reference lab that performs the testing. All DCH labs must go to DCH for testing & All Select Lab tests must go to Quest. Please alert the front & nursing staff of your insurance.

 

Minors:

If a patient is a minor (18 years or younger), the parent or guardian is responsible for any payment due at time of service.

Please understand that both parents are financially responsible for payment on the account under all circumstances.

 

Returned Checks:

If your check is returned to NorthRiver Primary Care Associates unpaid, a $30.00 returned check fee will be assessed in addition to the amount of the returned check. We can only accept cash or credit card payments for the returned check and fee. Both the check amount and fee must be paid together. If left unpaid, your check will be turned over to the Worthless Check Unit for collection.

 

Completion of Forms:

There is a fee and a 48-hour waiting period for all medical record copies and completion of medical forms. Please do not ask the physician to complete forms in the room or leave them with him. All forms must be reviewed for accuracy and completion and we need to have a copy for your file. Please check with our office staff in advance on the cost(s) of each request. Also, to release any medical records, we must have a release of information signed by the patient or parent/guarantor. Due to HIPAA regulations, when picking up records/information, please bring your Driver’s License or ID for verification.

 

Appointment Cancellation:

We request a minimum of 24 hours notice if you are unable to make your Routine or Weight Loss scheduled appointment.  This allows our staff the opportunity to reschedule your appointment for you as well as to work in patients without a current appointment.
 

There is a $50.00 No-Show Fee for all Routine/Wellness/Chronic Care/Sick (Walk-In) Appointments that are not cancelled/rescheduled & a $50.00 fee for all NorthRiver Wellness & Weight Loss appointments that are not cancelled/rescheduled within the requested time.

A ‘No-Show’ is defined as a patient’s failure to cancel/reschedule your appointment at least 24 hours in advance.

Prescriptions:

We will refill your prescription as soon as we are able but please allow a 48-hour turnaround time. No routine prescriptions will be called in at night or on the weekend. There is a charge for prescriptions that must be printed.  Due to HIPAA regulations, when picking up records/information, please bring your Driver’s License or ID for verification.


Billing FAQ

Why do you need to see my insurance card?

Your insurance card provides an incredible amount of information needed for billing purposes; such as your membership number, effective date, group number, billing address, type of plan, co-pay amounts and often much more. Once we have the information in our system, we need to review your insurance card in subsequent visits to ensure that our information is current and verify that there have been no changes in your insurance plan. This prevents a lot of billing confusion, and limits the chances that we send you a bill because of incorrect insurance information.

Will my insurance pay for the whole visit?

It is vital for you to understand exactly what your health care insurance policy will provide. You are responsible to pay any required co-pays and deductibles. Your insurance company dictates whether you should be billed for any unpaid balances. Not all health care plans offer the same benefits. There may be services that are not covered because the insurance company may consider them routine, preventive or unnecessary. Even within the same insurance company, plans differ depending on the contract/policy you are enrolled in. Providing quality care is our primary goal and we are more than willing to provide such care within your insurance contract guidelines. However, as those guidelines differ from one policy to another, it is your responsibility to know your coverage based on your insurance plan.

Can I have my copay billed?

Like most medical practices, we require that you pay your co-pay at the time of your appointment. It is also the expectation, and often the requirement of your insurance company to do so at the time of service. The purpose of the co-pay is to off-set the cost of your insurance premiums. Medical practices have contracted agreements with insurance companies to submit claims directly to them for the convenience of the patient with the understanding that they would not bear the additional cost of billing patients for the co-pay amount. Please do not expect or ask us to “bill” you since the cost of sending a statement is often as much as the actual co-pay amount.

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