Financial Policy

Wellspire Medical Group (Wellspire) is committed to providing you with quality care.  Your clear understanding of our financial policy is important to our professional relationship. To assist us in this, please provide:

• All necessary information for the billing of your claim, including your insurance card, employer information and demographic information.
• Satisfy all insurance co-payments, deductibles and non-covered services on the day services are rendered.
• Provide your insurance company and Wellspire with any additional information requested to complete the processing of claims filed on your behalf.

INSURANCE

Insurance is a contract between you and your company. We are not a party to your contract. We will not become involved in disputes between you and your insurance company regarding deductibles, non-covered charges, co-insurance, secondary insurance, coordination of benefits, pre-existing conditions, or “reasonable and customary” charges other than to supply the factual information as necessary. You are responsible for timely payments of your account. Wellspire Medical Group is filing your claim as a courtesy. This does not relieve you of financial responsibility of non-covered services or supplies.

If you feel you have made an overpayment to our office or are awaiting a refund based on insurance reimbursement, please contact our Billing Office at 281-446-7173 and select option 3.

WORKER’S COMPENSATION AND MOTOR VEHICLE ACCIDENTS

Wellspire does not file Worker’s Compensation or insurance for motor vehicle accidents. You will be expected to pay by cash or credit card. Checks are not accepted for Worker’s Compensation or motor vehicle accidents.

CONTRACTED MANAGED CARE PLANS (HMO, PPO, POS, EPO) AND REFERRALS POLICY

Each time you make an appointment with a Wellspire physician, it is your responsibility to make sure he/she is currently under contract with your managed care plan.  Verification of your coverage and benefits may be required. Often this verification requires us to share the reason for your visit with your managed care plan. Please plan to show you current insurance card at each visit.

If you are referred to a specialist or decide you need a specialist, you may be required by your managed care plan to call your Primary Care Physician in order to obtain an insurance referral. It is your responsibility to keep track of the expiration dates and for giving your doctor’s office a minimum of 72-hours’ notice before being seen by a specialist. If you allow the referral to expire without use, Wellspire charges a $15 fee to process a new referral. Retro referrals may not be allowed on all managed care plans. Therefore, if a referral is not obtained, you may be held responsible for payment in full by the specialist.

DISABILITY, INSURANCE FORMS, AND MEDICAL RECORDS

There is a $25 dollar per form charge to fill out disability, FMLA, and other health related forms. Please mail or leave forms at the front desk with your payment. Forms will not be completed until payment is received. Please allow at least 3-5 business days for processing. You will receive a phone call once completed to pick up your form. We will not mail or fax these forms.

The cost of medical records are dictated by state and federal statutes.  A list of fees will be given upon request.