Welcome and thank you for choosing Fleur De Lis Family Healthcare of Cankton as your primary care provider. Our mission is to deliver primary healthcare services to the community through health screening, health education, wellness promotion, identification and management of acute or chronic illness, and appropriate referral within the healthcare system in a timely and affordable way that is accessible to all in the community. We are committed to providing you with quality and affordable healthcare. One important aspect of optimal patient care is to have an agreement as to financial responsibility to avoid any misunderstandings and to ensure timely payment for services.
Fleur De Lis Family Healthcare of Cankton policy requires that all patients sign the Authorization and Consent for Treatment Form prior to receiving medical services. The form confirms that patients understand services being provided are necessary and appropriate. The form also advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
Please read this policy and ask any questions you may have. Any violation will be subject to the restrictions outlined below.
Patient/Parent/Guardian ResponsibilityPatients or their legal representative are ultimately responsible for all charges for services rendered. Payment is expected at time of service for all charges owed for the current visit as well as any prior balance. For those insurance plans with real time adjudication, payment will be collected at check out for charges incurred that day. For insurance plans that do not provide immediate patient responsible information, settlement of your balance can be accomplished, or you may pay a deposit on date of service. Patients or their legal representative should contact the insurance carrier to determine the schedule of benefits and if a co-payment or deductible applies. It is expected that the patient or their legal representative arrive for appointments with proper documentation.
For Annual Wellness visits or Physical Exams for which you require additional services beyond the scope of the wellness exam or physical, an additional charge will be incurred, and you will be asked to pay resulting additional copayments or patient responsibility amounts.
Types of Patient Payments
- Co-payments: We are contractually required by insurance carriers to collect co-payments at the time services are rendered. Co-payments must be made when you check in at the front desk. The patient’s appointment may be rescheduled if he/she is not prepared to make this payment. This arrangement is part of your insurance contract and failure to pay is a violation of that contract. Please help us in upholding the law by paying at each visit.
- Deductibles: Some insurance plans require patients to pay a predetermined amount before services will be covered. You will be expected to pay 20% of the day’s charges at the time of check-out. Any remaining deductible amounts must be paid prior to your next scheduled office visit. Failure to comply may result in rescheduling.
- Co-insurance: Some insurance plans require that patients pay a predetermined percentage (for example 20%) of the allowed charge amount. If the amount can be determined at time of service, amount will be collected.
- Uninsured Patients (Self-Pay or Private Pay): Persons with no insurance will be expected to make full payment at the time services are provided. Accounts must be maintained in a current status. If the total charge amount is not available at the time of checkout, the patient will be required to pay a deposit that will be applied to his/her charges. If the deposit exceeds the actual charges, then a refund will be issued. Delinquent accounts may not have access to work excuses, any indigent medication program, and are susceptible to rescheduling if unable to bring account current.
- Out-of-Network: Patients being seen as Out of Network will be required to pay a payment for that day’s visit at the time services are rendered. We will courtesy bill your insurance company. If the total charge amount is not available at check out, the patient will be required to pay a deposit that will be applied to his/her charges as described in the Payment Responsibility section above.
- Non-Covered: “Non-covered” means that some and perhaps all services you receive may be non-covered or not considered reasonable or medically necessary by insurers. If a patient is unsure whether a service is covered by his/her plan, it is ultimately the patient’s responsibility to call his/her insurance carrier to determine what the schedule of benefits allows. If non-covered services are provided, the patient will be expected to pay in full for the services at the time of service. Under no circumstances will our billing staff falsify or change a diagnosis or symptom in order to influence an insurer to pay for care that is not covered.
For Medicare, all non-covered services will be communicated to the patient prior to treatment and documentation of his/her acceptance of financial responsibility will be obtained prior to providing treatment. The Centers of Medicare and Medicaid Services (CMS) has mandated the form "Advance Beneficiary Notice (ABN)" to be used for this notification.
For Medicaid, a patient enrolled in an LA Medicaid program that requires a Primary Care Provider (PCP) designation must be enrolled with our clinic as their PCP. If we are not the PCP, a written referral must be obtained before being seen at our facilities. Failure to obtain this referral will result in all the charges incurred at that visit payable at check out.
InsuranceFleur De Lis Family Healthcare of Cankton participates in most insurance plans, including Medicare and Medicaid. If you are insured by a plan we do business with, but don't have a current verifiable insurance card, payment is expected in full at each visit. Please contact your insurance company with any questions regarding coverage. We ask that you familiar with your insurance policy to be fully aware of any limitations of the benefits provided.
Knowing your insurance benefits is your responsibility. All patients must present their insurance card (if applicable) and proof of identification (for example: Driver's license, Photo ID). Patients who do not provide current proof of insurance may be billed as a self-pay patient. If at a later time the patient presents his/her insurance card(s), services already rendered may or may not be retroactively billed depending on the insurance's claim filing requirements. As a courtesy, our office will file the forms necessary so that you receive the full benefits of your medical coverage.
Our office will make a good faith effort to assist you in obtaining your benefits, however it's at the discretion of your insurance company to pay for the services we have provided to you. We will submit your claims and assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. The patient's insurance is a contract between you and your insurance company and/or your employer and your insurance company. Fleur De Lis Family Healthcare of Cankton is not a part of this contract. For this reason, we cannot waive copays or deductibles.
Outstanding BalancesStatements are generated on a twenty-eight (28) day cycle. All statements are considered to be correct unless Fleur De Lis Family Healthcare of Cankton is notified within thirty (30) days of the statement date if you think there is a discrepancy. Requests received after that time will be the responsibility of the patient. Statement amounts are due and payable upon receipt. Questions may be directed to the billing office at 337-668-4141. Any outstanding balance that is due from the patient is payable in full upon receipt of statement. In the event a patient presents for an office visit and has an outstanding balance, a request for payment will be made.
Patients who fail to respond to statements will be placed into collection status. Patients with an outstanding balance for more than ninety (90) days may be referred to an outside collection agency and will be charged a $20 collection fee in addition to the balance owed.
A patient with unpaid delinquent accounts or accounts which have been written off to bad debt may not receive additional scheduled services unless special arrangements have been made. The patient may be discharged from the practice, however, in all situations the urgency of treatment will be taken into consideration.