Billing Information

THIRD PARTY PARTICIPATION AGREEMENTS
Charleston Internal Medicine, Inc. (CIM) has written participation agreements with many of the larger carriers in our area. When scheduling an appointment, or coming to our office, please verify that we participate with your health plan so you can receive the maximum financial benefit offered by your plan. If your insurance coverage is based on a co-payment, you will be expected to pay the co-pay at the time of service as well as any outstanding patient balance due. The patient due balance will be the amount your insurance has told us is the responsibility of the patient after they have processed the claim.
 
OUR FEES
Our fees are determined by analyzing charge information provided in publications at both the national and regional levels. The provider determines the level of service that is rendered and subsequently billed. Services and their associated fees vary depending upon the type of service, the level of care, length of visit, and the complexity of encounter. Factors such as the number of body organs involved in your condition and the process involved in coordinating your care with other providers is also a part of determining the total level of care that will be billed.
 
INSURANCE BILLING
CIM will bill any insurance we have on file for your account. We will allow them a period of 60 days to remit payment. If we do not hear from the insurance by that time, we will look to the patient to remit payment for services received. You have a financial agreement/relationship with your carrier for the processing and payment of your claims. CIM is not part of that agreement. You are encouraged to communicate with your insurance if you feel your services are not properly processed for payment.
 
 
UNIVERSITY OF CHARLESTON- STUDENT HEALTH ACCESS PLAN

Charleston Internal Medicine, Inc. (CIM), in cooperation with the University of Charleston (UC), is pleased to offer a Student Health Access Plan to the students of UC.   This program is designed to ensure that when a student needs medical care, they have access to comprehensive quality care in a timely manner, with a minimum of interruption to class attendance and studies.

 

The Student Health Access Plan allows a student to call our office and receive a same day appointment for acute conditions.  Non-acute conditions will be offered an appointment within 72 hours.  All the student must do, is call CIM before 3:30pm and talk with the receptionist about their conditiona and/or symptoms, and the student will be given a time to come and see a provider for medical care.  This easy process keeps the student from spending countless hours in an emergency room or urgent care facility and more time in the classroom and on campus.

 

The program is available to all full-time University of Charleston students.   The Student Health Access Plan is not health insurance coverage.   It is only an enhancement to the student’s current health care coverage plan.   Here is how it works:

 

1. The student signs up for the Student Health Access Plan through the Student Life Office at UC.  

2. UC will bill the student $75 per semester if the student has valid third party insurance coverage.  If     
    the student is not covered by any third party payor, the cost of the plan is $150 per semester.
3. The UC Student ID Card is noted that they participate in the program.  

4. When the student needs medical care, they call our office at 304-720-2345 and request

    an appt.   If they call by 3:30pm they will be seen that day.  

5. The student is required to bring the following items with them to each appointment:
                      a.  UC Student ID Card
                      b.  A valid insurance card- if applicable.
                      c. Demographic information including date of birth, social security number, address, etc.
                         of the person that holds the insurance policy.  
6. Appropriate care is rendered by a provider in our office

7. The student is back on track to being healthy and returns to classes and studies.

 

The billing for the office visit is handled as following:
            1. CIM collects all the necessary demographic and billing information from the student at the visit.
            2. CIM bills the insurance carrier- if applicable
            3. CIM accepts what the insurance pays as payment in full.  If the student does not have any third
                party coverage, then CIM does not bill the patient for services covered under the plan. 
            4. Additional services, such as, but not limited to, laboratory work, x-rays, diagnostic testing,
                immunizations, injections, etc. are not covered under the Student Health Access Plan.  Those
                services will be billed to the patient's third party insurance carrier, and if applicable, any remaining
                balance will be billed to the patient, as instructed by the insurance carrier.    If the  student  does
                not have any insurance coverage, these services will be due from the patient at the time of  service.
      

Additionally, should the student require hospitalization, all CIM provider services will be covered in the Student Health Access Plan.  This does not include any fees or services provided by and billed by the hospital or a non-CIM provider.  Those fees are not covered under the Student Health Access Pass and are the responsibility of the patient/student.

   

Here are examples of how the Student Health Access Plan works:
EXAMPLE 1
A student has Blue Cross and Blue Shield of Virginia and their insurance card lists a $20 co-payment for a primary care provider.
 
The student is seen on September 22nd.  The student is seen by a CIM provider.  CIM bills the insurance $80 for the office visit.  Blue Cross and Blue Shield of Virginia processes the claim and they approved $70 for the service and the patient is responsible for a $20 co-payment plus the insurance applies $50 to the patient's deductible. 
 
CIM receives the Explanation of Benefits from the insurance.  CIM writes off $10 as a contractual adjustment- which is required by our contract with the carrier, then writes off the $20 copayment and then writes off the $50 that was applied to the deductible as a Student Health Access Plan adjustment.  The patient's/student's balance due is $0.00.
 
EXAMPLE 2
A student has Aetna insurance and a PCP is listed on their insurance card.  The card also says the PCP co-payment is $10.
 
The student is seen on September 22nd.  CIM bills the insurance $80 for the office visit.  Aetna process and deny the claim because CIM is not the PCP listed on the patient's insurance card.  They state that the full $80 is due from the patient.
 
CIM receives the Explanation of Benefits from Aetna.  CIM writes off the $80 as a Student Health Access Plan adjustmemt.
 
EXAMPLE 3
A student has Benefit Assistance Insurance with no co-payment listed on the insurance card. 
 
The patient is seen on September 22nd.  The insurance is billed $80 for the office visit.  Benefit Assistance processes the claim and pays $64 and says the remainder, $16, is due from the patient as co-insurance.
 
CIM receives the Explanation of Benefits from Benefit Assistance.  CIM applies the $64 payment and writes off the remaining $16 as a Student Health Access Plan adjustment. 
 
If you have questions about the Student Health Access Plan, please contact the Office of  Student Life at the University of Charleston, at 304-357-4745 or call our office and ask to speak with Tricia, our Billing Specialist.