William E. Jones, MD

You are probably entitled to collect substantial out-of-network reimbursement from your insurance plan for every visit to our office, but you must be diligent to make sure that your insurance company doesn't try to cheat you out of your full benefits the way they used to try to cheat us.

Here's what you must do to protect yourself against underpayment
(We've made the process VERY SIMPLE for you):

At each visit we will give you several items:
     (A) A receipt for the charges that day
     (B) A completed standard insurance claim form (HCFA)
     (C) A photocopy of the HCFA (so you won't have to bother making a copy yourself)
     (D) Even an envelope that we've pre-addressed to your insurance company for you.    (Does my staff keep you spoiled, or what?)

     Both the receipt and the HCFA list the five-digit "CPT codes" (Procedure Codes) for every charge; but only the receipt includes a description of each individual service you received; so hang onto it.
Sign and date Item 12 on the HCFA. Do not sign Item 13 because we want the payment to come directly to you, not to us.
Now simply affix a stamp to the envelope we've provided and mail the pink HCFA form to your insurance company. (That's all there is to it. Pretty simple, huh?) Be sure to record the date you mail the HCFA.
KEEP YOUR PHOTOCOPY OF THE HCFA insurance claim form and file this away along with your receipt describing the charges.
Later, when you receive your payment check from the insurance company, you must check off each item on your receipt against the payments shown on the insurance company's EOB (Explanation of Benefits) list that accompanies your payment to make sure the company didn't "inadvertently" (and with not notice whatsoever) simply omit payment for one or more of the line items. (Rita used to have to watch these companies like a hawk, and she often detected deliberate insurance company omissions or improper reductions in payments.)
If you have any questions about whether your insurance company paid you the full reimbursement to which you are entitled, feel free to phone Rita; and she'll be glad to go over the claim with you. Please understand, though, that my office staff will no longer communicate directly with your insurance company on your behalf. We will be happy to coach you and furnish you with any documentation requested by your insurance company, but it will be solely your responsibility to deal with your insurance plan.