SHADOW CREEK MEDICAL CLINIC
11021 Shadow Creek Pkwy,
Suite 102, Pearland, TX 77584
FAIRWAY MEDICAL CLINIC I
4910 Telephone Rd,
Houston, TX 77087
FAIRWAY MEDICAL CLINIC II
7701 W Bellfort St, Suite B,
Houston, TX 77071
Our office is in network with most major insurance plans. Here is an up to date list of insurance companies that we are contracted with. When you present to our office you will need to bring your insurance card with you as proof of current coverage. It is your responsibility to provide us with your accurate information & it is fraudulent to knowingly present invalid insurance information. Please make sure you notify the staff of any changes in your insurance coverage as soon as possible. We ask that you present your current insurance card at every visit because although you may think you insurance information is the same as it was at a previous visit; however that is not always the case.
We will NOT file your insurance claims without a copy of your current ID card. If you need medical services and you do not have your insurance card, you may still keep your appointment. However, you will be asked to pay for services in full prior to being seen. We will quote you the best estimate possible based on the reason for your visit; however it is not a guarantee that there will not be additional amounts due at check-out based on what was actually done during your visit. All insurance companies have a deadline for claim filing and if you supply us with your insurance card within that time frame we will file your claim. When the claim is paid, you will be reimbursed for any overpayment you made. If we do not receive the information until after the claim filing deadline has passed, we will not submit the claim, therefore you will not be able to get any reimbursement from us for your visit.
It is your responsibility to notify us in a timely manner of any insurance changes. Ultimately you should notify us prior to checking in for your appointment, or even on the phone when scheduling so we can make a note of the change to ensure we ask you for the updated information. All insurance companies have a limit on the amount of time we have to file a claim; for example Cigna claims cannot be filed more than 90 days after the date of your visit, United Health Care allows 45 days. Since it is your responsibility to give us the correct information you are the one held accountable if you do not furnish us with the correct information to be able to file your claim within that time limit and you are responsible for the entire charged amount.
DOUBLE INSURANCE COVERAGE
If you are covered by two plans, usually you are the subscriber for one and a dependent on the other plan. The plan for which you are the subscriber is your primary carrier. By law, your claims must be filed with it, before submitting them to your secondary plan. You do not have the option of designating your secondary plan as primary and it is fraudulent to conceal the existence of a primary plan from a secondary one. We typically only file claims directly to primary insurance plans. If you have a secondary insurance, upon request, our billing office will provide you with a form of itemized charges that you can use to file to that plan. The only exception our office makes is if your secondary coverage is with Blue Cross Blue Shield, Medicare, or Tricare because we are required by our contracts to file the secondary claim for you. Regardless of your secondary coverage you are responsible for any balances due after your primary insurance company pays.
OUT-OF-NETWORK COVERAGE & NON-COVERED SERVICES
While our office has contracts with most of the major health insurance carriers, that does not guarantee that our practice is contracted with each individual plan those carriers offer. It is ultimately your responsibility to check with your insurance company prior to your visit to verify that we are listed with your plan as in-network providers. Due to the volume of available plans currently in the insurance market, we are unable to know the coverage offered by each of these plans. We will do our best to keep you as informed as possible based on current information our practice has been given by each insurance carrier, but we cannot be held liable for services you receive that are processed as either out-of-network or non-covered by your individual plan.
If we are not contracted with your specific insurance plan, it is our office’s policy that payment is due at the time services are performed. We will gladly provide you with an itemized form of your charges that you can use to file a claim to your insurance company with. Also, keep in mind that if we are not contracted with your insurance company we are not held by their negotiated rates and you therefore may not be reimbursed 100% of what you paid by your insurance company.
CO-PAYS, CO-INSURANCE & DEDUCTIBLES
We are required by your insurance plan to collect co-pays on the date of service. This will be collected upon check-in or check out along with any other balances owed on your account. Failure to do so will result in your appointment being rescheduled to the next available open appointment time on another day except in the case of emergent medical situations. We also reserve the right to notify your insurance company if you fail to pay your co-pay, and other “out-of-pocket” charges, such as deductibles and/or co-insurance which is a breach of your personal contract with your insurance carrier and may result in your insurance company terminating your coverage. For your convenience we accept Cash, MasterCard and Visa. We DO NOT accept personal checks.
ANNUAL EXAMINATIONS vs. PROBLEM VISITS
As a commitment to your health, Dr. Mussaji recommends that every patient have a “Routine Physical” that enables them to evaluate your overall health and make sure you are not developing any unexpected problem or illnesses. Unless there is a major new finding, or a significant medical problem which must be addressed, we must submit the service to your insurance company as a routine, annual or preventive examination.
Dr Mussaji may recommend that screening tests are performed during your routine physical exam. Despite being recommended by your physician, it is possible your insurance will not consider them medically necessary, even if a positive family history for a condition exists. Most insurance plans have specific guidelines for coverage of screening tests and if your insurance determines the tests to be non-covered, you will be responsible for paying for them. The tests cannot be submitted as anything other than screening, unless you have specific, documented symptoms on the date of service that warrant the test. Even if the results of these screening tests show some problem, if they were done for screening purposes they must be submitted that way to your insurance company, and we cannot change the information on the claim for payment purposes.
If there is a new problem discovered during the routine exam that requires attention, or a significant medical problem requiring additional time and/or decision making on the part of the physician, we will be required to bill a consultation visit to your insurance along with the routine physical exam. You have the option to tell the provider that you do not wish to address any issues outside of the routine physical exam. The annual exam itself cannot be filed as problem related and will be filed as routine. The consultation will be filed as problem related, with the appropriate diagnosis for the problem. If you choose to combine routine physical with the problem related consultation, it is extremely likely that your insurance company will determine that you are responsible for co-payments, coinsurance OR deductible for the problem related consultation. You are responsible for payment of any portion of your charges not paid by your insurance (excluding contractual write offs) including, but not limited to, co-payments deductible or coinsurance if applicable. We have no control over how your individual insurance company and chosen policy choose to process your claim and assign patient responsibility. We understand that sometimes it is not possible or convenient to return for a separate visit to discuss these additional issues and Dr Mussaji is concerned about your health care above anything else. Therefore we are more than willing to take care of all of you needs during you routine exam instead of causing an inconvenience by asking you to return for a separate visit for your problems. However, we must file those diagnosis codes to your insurance company along with your Routine Physical exam.
CANCELLATION POLICY & UNCONFIRMED APPOINTMENTS
If you do not show up for your scheduled appointment and you have not notified us at least 24 hours in advance, you will be subject to a $50 cancellation fee.
Our staff calls to confirm appointments a day prior to your appointments. However, some of them do not get confirmed due to missed calls, voicemail box full, no voicemail box etc. Please return our calls to confirm your appointment. Time slots of those who have not confirmed will be given to someone else and you will be asked to reschedule. We insist on confirming your appointments with us, due to limited appointment availability.
PRESCRIPTION & REFILLS
Please call for prescriptions and refills during office hours. We electronically prescribe medications; therefore make sure your local pharmacy receives electronic prescriptions. For refills, you should call your pharmacy to fax us a refill request. Our fax number is 713 641 3901. Please allow 2 days, if your medications are not urgently needed. If your refills are urgently needed, we suggest you call the office to let the staff know. Please do not wait to refill your medications till the last pill.
TESTS & LAB RESULTS
As a general rule, we will contact you with your lab values, no matter the result. Results take about 2 to 3 days to arrive from the lab. Patients whose Lab results are abnormal will require a consultation visit to the office. We do not discuss abnormal test results over the phone. Cultures take at least 24-48 hours before results are ready. When labs are ordered, please be aware you may receive a separate bill from the lab that performs the test.
PAPER WORK & REQUESTING MEDICAL RECORDS
There is a $25 medical record copying fee, unless requested in an emergency/life threatening situation. Any extensive paper work such as Disability Placards, FMLA paperwork, Metro Lift Forms etc. will require a fee of $50. Paperwork for School Physicals, Sport Physicals and Cab Physicals will be part of physicals pre-set cash prices (They are not covered by insurances).