Frequently Asked Questions
Health care and its costs have become increasingly complicated over the last few years. We encourage our patients to fully understand their policies so we came up with a brief explanation for the items which seem to puzzle patients most. Here are the answers to some questions that seem to come up repeatedly.
Why am I getting a bill from your office even though you participate with my insurance, and I already paid a co-pay at the time of my visit?
There is a multitude of plans each insurance carrier designs, and each plan has its own specifications. In the majority of cases, your employer purchases a plan which is then used for all employees and dependents. This plan may have a DEDUCTIBLE and/or a CO-INSURANCE clause, which means that YOU are responsible to pay out-of-pocket for part of all the expenses up to an individual yearly total. In essence, in addition to your monthly payment deducted from your check, and your visit co-payment, you pay cash for part (or all) your treatment until you reach a certain limit (the deductible). From then on, the insurance will make all payments to the doctor.
What should I do if my bill seems wrong to me, or if I do not understand it?
Medical bills, and the breakdown of adjustable, write offs, etc. can be very confusing. First, make sure you have a bill with our letterhead and not an EOB, or explanation of benefits, sent to you from your medical insurance company. Not all EOBs which show that you owe us money mean that you will actually receive a bill, as we write off many services not reimbursed. Second, call your insurance company, and reference the date of service to clarify if any given fee has been applied towards your deductible. If you still have questions please mail us a copy of your bill with a brief, typed, explanation of your question. You can also email it to firstname.lastname@example.org and we will forward this to Claimpower, our billing partner. Use “Billing Question”as the subject. Claimpower will investigate and contact you with further instructions.
Why do I have to pay a co-pay when I return for my "follow up physical" even though my yearly physical is FREE in my insurance?
The FREE physical is ONLY the first visit of your yearly check-up. This visit is meant to review your personal and family medical history, medications, as well as have the physical examination and issue referrals if necessary. Additionally we get blood and urine to be sent to the laboratory. During the second visit we review the blood work results, and perform needed testing such as EKGs, spirometry, etc., as well as make a "wellness plan" for the rest of the year. Both the testing and the plan are highly individual and address the physical and emotional needs of each patient. We feel that the physical examination is not complete without a discussion of your results. This visit though, is considered an OFFICE VISIT by your insurer and therefore requires a copayment. Physicians are LEGALLY bound to collect a co-payment EACH time a patient is seen for an office visit.
Why do I have to pay a $25 dollar fee if I cancel an appointment less than 48 hours in advance?
We schedule patients to optimize efficient medical care. We are proud that we offer same day appointments almost every day, and that our practice has a part time gastroenterologist, dietician and podiatrist. Consequently when you cancel less than 48 hours before your appointment, you leave a hole in our schedule which can not be filled except rarely. Canceled appointments deprive other patients of the opportunity to be seen, and our practice of income. The fee is not meant to be a punishment, but rather is meant to discourage patients from cancelling appointments. All primary care practices as well as specialists have similar policies. We will enforce this fee, which must be paid before you see the doctor.
Can I be guaranteed to see Dr. Cernea ONLY at my appointments?
D.C. Medical Care LLC is a group practice and has several licensed primary care providers working under Dr. Cernea' s supervision. Each member of our team has many years of clinical experience, excellent diagnostic skills, and cares deeply about our patients. All cases are reviewed by Dr. Cernea personally almost always on a daily basis. Therefore patients are seen on a rotating basis by all team members, and request for a specific provider can not be accommodated.
Dr. Cernea does have a small Concierge practice where each patient has immediate and exclusive access to Dr. Cernea. This is a "pay in option", and details can be obtained on request.