Please read the FAQ below.
We are committed to being in-network with Insurance companies. Accordingly, patients and our office must deal with their very complex rules. It is your responsibility to be familiar with the technical details of your policy.
Office Practices and Billing
Q: What is the definition of a Preventive Visit (“Annual Physical”)?
A: This answer is clearly explained in your insurance company's policy manual. It is your responsibility to read and understand this.
A Preventive Visit includes a history and physical exam, and relevant immunizations and screening exams, as defined by the USPSTF (United States Preventive Services Task Force).
A Preventive Visit *does not* include evaluation and management of any medical problems discussed at the visit.
For example, if you come in for a Preventive Visit, and have an additional complaint (e.g. a cough, or a twisted ankle, or a skin lesion) this is considered an additional Problem Visit, and will be billed in addition to the Preventive Visit.
Please see the Mayo Clinic for further explanation.
Q: I came in for a Preventive Visit (“Annual Physical”) and there is supposed to be no copay/deductible applied. Why am I getting an additional bill?
A: Please see the above. Most likely you had a Problem Visit in addition to your Preventive Visit.
Please see the Mayo Clinic for further explanation.
Q: I reviewed my EOB. How are CPT (Current Procedural Terminology) codes determined for each visit? How can I check if there was a mistake?
A: After the Affordable Care Act, almost all patients now have deductibles of $1,000 or more. It is important you have open and transparent communication with the office regarding billing issues. Unfortunately, insurance company rules for medical coding are ridiculously complex, as any doctor will tell you.
These companies utilize a complex formula including History of Present Illness/Issue, Review of Systems, Past Medical, Family, and Social History, Physical Exam components, and Medical Decision Making (comprised of a complicated "point system" noting Diagnosis and Management, Data gathering, and Risk calculations).
Non-physicians actually to go special school to get certified in understanding this stuff!
For example, evaluation and management of sexual health issues involving men who have sex with men (MSM) are high risk as HIV prevalence is extremely high in the NYC metropolitan area. However, management of a simple bug bite, depending on context, would be considered low or moderate risk.
If you believe there is a mistake in your EOB, please call the insurance company first. Understand that the insurance company representative may have less than perfect knowledge of this area. If you still have questions, please contact us at firstname.lastname@example.org to discuss further, and we will be more than glad to help.
If you would like to learn more about the technical details of medical coding, please follow this link.
Q: I reviewed my EOB. Which ICD10 (diagnosis) codes refer to PrEP evaluation and management and prevention? Shouldn't this visit be "covered"?
A: Each insurance company may have hundreds of sub-plans, each with its own idiosyncratic policy regarding coverage for PrEP and PrEP related office visits, and whether they consider these visits "routine preventive" or not.
If you call to speak with a plan customer service representative, it is quite likely this individual will be unfamiliar with PrEP, and will have no idea what you are talking about. You will likely get different answers from different representatives at different times. It is extremely frustrating.
If you speak with a representative, keep in mind the ICD10 code associated with PrEP is Z20.6. Visits should always be "covered", but the amount owed may be applied to your deductible.
Q: My lab bill is really high, is this a mistake?
We have noticed lately that insurance companies are often not honestly paying laboratory service bills. Please follow this link and read very carefully as it may save you time and money.
Q: Is Dr. Vitt in-network with my insurance plan?
A: To see if Dr. Vitt is In-Network, visit our In-Network Insurances page.
Q: Do I need to specify Dr. Vitt as my primary care provider? How do I do that?
A: Many plans require that you specify a Primary Care Provider in order for your visit to be covered. To find out if your plan requires it and to make that selection you may call the Member Services number on the back of your card. Be sure to give the Operator Dr. Vitt's ID number which can be found here under your insurance plan.
PPO plans generally do not need to specify, however it may vary.
Q: Why do I have to give you my credit card information?
A: We regret very much that the conduct of your insurance company now requires that you provide authorization for credit card billing for each office visit at time of your visit. This office policy is necessary because your insurance company will not guarantee that when we verify your coverage that the information they provide us with is accurate. Your insurance company regularly denies responsibility for bills even after they have provided verification and even demands refunds for services provided to patients' years after the date of service.
We will of course continue to bill your insurance carrier, and should your insurance company accept responsibility for your bill, you will be responsible only for any co-payment and deductibles. These have to be paid at time of service, as they are now. If your insurance company declines to accept responsibility for all or part of your bill, your credit card will be charged for the services provided. If your insurance company is wrong, and subsequently makes payment, we will of course promptly issue you a refund.
Q: Will you ask before you charge my card?
A: If the amount due exceeds $500, we will ask before we charge. If the amount is less than that, we will charge the authorized card on file as soon as your insurance company informs us that patient responsibility is due. We will email you a receipt.
Q: What is the HIE (Health Information Exchange), Care Everywhere, Healthix consent form?
A: By giving consent on this form you authorize participating hospitals and facilities to access your health information in the event that you are admitted, and vice versa. For details, see the Fact Sheet.
Q: Can you send my medical records to another doc?
A: Yes we can. Please fill out this form and email it to Office@DrVitt.com with specific instructions on what information you'd like us to send, if not your complete medical record.
Q: Can my previous doc send you my medical records?
A: Yes. Please fill out this form and send it to your former doctor.
Q: Is this office compliant with HIPAA requirements?
A: Yes. Please click here to see our Notice of Privacy Practices.
Q: My insurance company is not covering my Gardasil-9/ Gardasil HPV, Menactra/Meningitis or Hepatitis vaccine. How can I appeal this?
A: Call the member services number on the back of your card. Inform them this vaccine should be covered as per the Affordable Care Act/CDC/ACIP guidelines. Moreover, if you are a man who has sex with men under the age of 27, then this should be covered. For CDC guidelines on Gardasil click here. For CDC guidelines on Menactra click here. For CDC guidelines on Hepatitis click here. If your appeal is successful and your insurance company covers the service, you will be refunded the vaccine fee charged to your card.
Q: Can you recommend a good resource to learn more about Truvada prep?
A: Check out the PrEP facts website.
Q: Is there any way I can get my Truvada copay reduced?
A: To see if you are eligible for Truvada Copay Assistance, please visit this website.