If your insurance carrier isn’t covering services here, let us know by calling (608) 342-4714. We can reach out to that carrier to find out about accepting their coverage for you.
Providers at Southwest Health participate in most insurance plans. However, it is always wise to check with your provider’s office when scheduling your appointment to ensure that you will not encounter problems with your carrier.
We summarize below some important issues about insurance and managed care that, if neglected, can cause confusion. In general, you are responsible for charges not covered by your individual insurance plan.
Check with your insurance carrier
Your provider may not necessarily accept every plan that a particular insurance company offers. If you are unsure whether your doctor accepts your plan, call your insurance company. Verify the provider’s status before your visit. If your doctor does not accept your insurance plan, the bill will be your responsibility.
Medicare
Generally, all Southwest Health providers accept Medicare for covered services. This means that Medicare will pay 80 percent of Medicare-approved amounts, with the exception of certain services, such as clinical lab tests, which will be paid at 100 percent of the approved amount. Typically, this leaves 20 percent that must be covered by supplemental insurance or paid by you. In addition, an annual deductible must be satisfied each calendar year, and some Medicare plans have additional co-pays or deductibles that must be paid by the patient. Under federal law, providers are not allowed to write off these Medicare expenses.
Anesthesiology
Our anesthesiologists participate in most insurance plans. Although in most cases, insurance that covers your surgeon will also cover your anesthesiologist, plans can vary greatly. If you will require surgery, it is best to contact the Department of Anesthesiology to determine whether your anesthesiologist accepts your insurance.
Laboratory tests
Any laboratory tests that your provider may order during your office visit will be billed separately. Southwest Health Laboratory participates in most insurance plans and will charge your insurance company directly. However, you will be responsible for applicable co-insurance and deductibles.
Pathology
If your provider takes a biopsy, obtains a Pap smear, or collects a fluid specimen, these samples are sent to the separate Pathology Laboratory for analysis. Results of these tests require interpretation by a pathologist — a provider who specializes in laboratory medicine. As with laboratory tests, pathology services are billed separately from your office visit. Southwest Health pathologists participate in most insurance plans. However, some HMOs may exclude our laboratories from their networks. Check with your insurance provider to find out if any co-payments or deductibles may apply to these laboratory services.
Radiology
If your provider requests a radiology exam, please contact your insurance company to determine whether you require a referral. Radiology Services will send you a separate bill that may carry the name of a provider you do not recognize. This provider processed, read, and interpreted your test. Unless prior arrangements are made, test results are sent to the referring provider, not directly to the patient.
Emergency services
If you receive treatment from the emergency department, there is a chance that your visit would be upgraded from urgent care to emergency status. If you have questions about what your insurance carrier covers during those visits please call the 800 number of the back of your card.