INS, fees, and paYment

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1. Below are the financial policies for our clinic. We invite you to visit with one of our billing department members if you have any additional questions.

Patients with Private Insurance, Medicare, or Medicaid

• Family Health Center will bill your insurance as a courtesy.  Our billing department works hard to bill your visit accurately and timely.  To help in this process, please bring your insurance card with you to your appointment so that we can make a copy for your file.  Please remember that your co-payment and/or deductible is due at the time of service.
• We will do our best to help you understand your insurance benefits. However, it is the patient’s responsibility to know his or her benefits.
• If you have a concern regarding cost, please discuss any additional procedures with your physician before they are started.

e have a “self-pay” program (insurance will not be billed,) to work with our patients on their health care bills. $100 is due at check in at each visit

FHC self-pay program offers two (2) types of discounts:

● Sandpoint Family Health Center will offer a 50% discount, on applicable services, to any patient that pays in full at time of service. 

○ For items or services that have a direct cost associated with them (i.e., immunizations, medications, laboratory exams, specific equipment/durable medical equipment, etc.), the discount may be less, and the discount will be applied up to ensure direct costs are covered. 

● Payment plans – Sandpoint Family Health Center tries to be flexible with payment arrangements to assist patients with their cash flow needs, etc. Therefore, for a patient that is “self-pay” but unable to pay in full at time of service, a 25% discount will be applied to applicable services. 

○ For items or services that have a direct cost associated with them (i.e., immunizations, medications, laboratory exams, specific equipment/durable medical equipment, etc.), the discount may be less, and the discount will be applied up to ensure direct costs are covered. 

○ For specific devices or procedures (i.e. Contraceptive devices, specialty labs, etc.), a higher deposit may be required to cover FHC’s direct cost. 

Under the “No Surprise Act,” patients have a right to receive a Good Faith Estimate prior to receiving services. This estimate can be obtained from FHC prior to services being rendered, except in an emergency/urgent situation. FHC’s Self-Pay Program only applies to services rendered and billed by FHC. It does not include any services that are billed by an imaging center, hospital, pathology service, radiology group, anesthesia service, etc. Medicare Patients are excluded from the Self-Pay Program per our contract with Medicare.

Other Program Guidelines and Information

● FHC has a Flexible Payment Plan Program for patients. The Flexible Payment Plan Program Agreement is on the final page of this packet. The Flexible Payment Plan Program is for both self-pay and insured patients.

● For laboratory services billed by FHC, it is possible that once performing the ordered test a “reflex” or “add-on” test may be necessary as part of diagnosis and treatment. Should one of these tests occur, the applicable discount will be applied. 

○ Most commonly, this occurs with urine or wound cultures as an antibiotic susceptibility and identification needs to be performed to ensure proper treatment against resistant strains. 

○ This discount does not apply when labs are drawn here but billed by a 3rd party (such as LabCorp or Bonner General).

Collection Policy

● Self-pay patient balances are considered ready for 3rdparty collection actions when:

○ A monthly payment is missed and at least 30 days have passed since the last statement and/or payment and there has not been any communication to FHC’s Billing Department to discuss missed payment and make new arrangements.

○ Returned mail is received and FHC is unable to reach the patient/guarantor for an updated address and at least 30 days have passed since the last statement and/or payment and there has not been any communication to FHC’s Billing Department to discuss missed payment and make new arrangements.

○ Returned check or credit card payment for insufficient funds and FHC is unable to reach the patient/guarantor make new arrangements.

● Any self-pay patient balance that is transferred to a 3rdparty collection agency will have any discounts removed. The balance transferred to the 3rd party collection agency will be FHC’s full fee minus any payments that have been made. 

● Patients that are utilizing FHC’s self-pay program must provide the following, in addition to regular registration information:

○ Full legal name and date of birth

○ Valid/Current Driver’s License

○ Social Security Number 

● By 3rd party payer contracts/requirements, self-pay discounts cannot be applied to a patient/guarantor’s, in-network out of pocket costs (deductible, coinsurance, copay, cost share). Should a patient/guarantor choose to utilize FHC Self-Pay Program, insurance cannot be billed. FHC has a separate election form required for this process. 

We will bill most insurances, however, we contract with Blue Cross of Idaho, Regence Blue Shield of Idaho, Idaho Physicians Network (IPN), and First Choice Health Net to allow you to get your in-network benefits.  Please contact us at 208-263-1435 if you have any questions.

• AARP
• Aetna
• Blue Cross
• Cigna
• First Choice Health Network
• Great West Healthcare/Cigna
• Health Management Administrators (HMA)
• Health Net
• Idaho State Insurance Fund
• Medicare
• Medicare Advantage plans (ex: True Blue, Secure Blue, etc.)
• Medicaid of Idaho
• Pacific Source
• Railroad Medicare
• Regence Blue Shield of Idaho
• Secure Horizons
• Tricare Prime
• Tricare Standard
• United Health Care

Please call your the number on the back of your insurance card to find out if your policy is in-network or out-of-network with us. They will also be able to tell you information about your benefits such as deductible, co-insurance, and wellness coverage.