Insurance

A Review of Current Issues

The mission of The Greenbrier Clinic is to excel in the provision of comprehensive, adult diagnostic and preventive health care. An individualized approach, employing state-of-the-art equipment and testing procedures is coordinated over a two day period by medical staff and employees committed to making this process as comfortable, convenient, and informative as possible. In addition to evaluating any current problems or symptoms, your doctor will analyze your risk for other diseases and may recommend "screening tests" to detect problems such as cancer and heart disease in their early stages.

Many patients ask if their health insurance and/or Medicare will cover all or a portion of their Clinic examination. While most insurance plans and Medicare cover some portion of limited screening or preventive health services, many such tests are not covered. Tests such as chest x-rays, exercise stress tests, flexible sigmoidoscopy, cholesterol levels, blood tests for thyroid and liver function, and diabetes are examples. If such tests are performed for evaluation of specific symptoms or findings, they may be covered, but generally they will not be covered if performed for screening purposes. If you have questions regarding which screening services may be covered by your health plan, please contact your insurance carrier before your Clinic examination.

The Clinic is required by law to bill for all services using numerical "codes" that identify what tests were performed and why. The codes also identify the service as a diagnostic service or a screening service. An example of a screening test might be an exercise stress test in a patient with elevated cholesterol and a family history of heart attack, but no symptoms suggesting heart disease. Other examples might be tests performed to detect cancer in its early stages. Although doing such tests might be appropriate and desired by the patient, strictly speaking they are "screening" tests and must be coded as such by the Clinic. The use of these codes may reduce your reimbursement from an insurance carrier, and increase your out-of-pocket expense.

Medicare does not cover general preventive physicals. It does provide a very limited amount of preventive services. Medicare does cover annual breast examinations and mammograms; periodic pap smears; and colorectal cancer screening (every four years). It also covers annual prostate cancer screening for men which includes a digital rectal exam and a PSA blood test.

If Medicare is your primary insurance, please note: As a courtesy to our Medicare patients prior to 2000, the Clinic included codes in its Medicare billing for services Medicare considered to be "non-covered services". Medicare denies these services but occasionally secondary insurance covers them. Medicare’s current policy is that they do not wish to have claims for "non-covered services" submitted. However, if you do have secondary insurance, we may, with your written authorization, bill for a denial. If you are a Medicare patient with no secondary insurance, these charges will be included on the bill you receive from the Clinic.

The Greenbrier Clinic is a participating provider with Medicare. The Clinic is not a participating provider with any managed care plan and most insurance plans. This means that if your insurance carrier covers a service but approves less than the Clinic’s fees, you will be responsible for reimbursing the Clinic for the remaining balance of the total billed.

The only exceptions to this are beneficiaries of the West Virginia Public Employees Insurance Agency (PEIA). We are required by law not to balance bill the non-allowed amounts determined by their fee schedule. The Clinic can bill its full charges to PEIA patients for services that are determined by PEIA to be non-covered services.

The Clinic cannot predict the total cost of your examination: The cost of our basic examination begins in the range of $1900-$2200. This can vary greatly depending upon your age, general health status, family history, ongoing symptoms, and any additional problems you wish to have addressed. The total bill may be as high as $4000-$6000 or more when symptoms requiring multiple sophisticated tests are evaluated. Insurance reimbursement often reduces out of pocket costs.

Patients who wish to receive the Clinic’s expertise in the evaluation of a condition or problem, but do not want the comprehensive Greenbrier Clinic examination, may schedule a problem-focused examination on a "space available" basis. If you choose this option, you will receive a high quality Greenbrier Clinic evaluation limited to your current symptoms or problems. This examination does not include screening tests or preventive health services and should not be considered a substitute for the traditional Greenbrier Clinic comprehensive evaluation.

As a courtesy, the clinic will continue to prepare and file your insurance claim forms for the services you received while a patient at the Greenbrier Clinic. This service is unique to the Greenbrier Clinic in fact many of our competitors no longer bill insurance but provide you with a super bill. This is a form used in the industry with the diagnosis and all appropriate coding information for services received so you can personally attempt to bill your insurance on your own. Some of these same organizations even refuse to accept Medicare patients in their Executive Health programs which we continue to accept. We feel that in today’s complex healthcare market it is important for the Greenbrier Clinic billing and coding experts to continue to assist our patients in preparing and then submitting the forms. This is one of the many services we provide that continues to separate the Greenbrier Clinic from the rest of the industry. Our highly trained billing and coding staff have years of experience preparing and submitting your insurance forms to assure, under the law, maximum allowable reimbursement from your insurance carrier.   

Effective immediately each time you check in you will now be asked to sign a credit card authorization form. This information will be held securely and only used to pay for the portion of your exam that your insurance did not cover . Additionally the new policy will also allow the clinic to bill your credit card in those instances when your insurance carrier pays you rather than the clinic. We will allow 60 days for your insurance company to process your claim and pay you for those services that are covered. 

At that point (60 days from date of services) we will now bill your credit card for the outstanding balance on your account. In order to minimize the amount billed to your credit card you should promptly send any money received from your insurance company for the services you received at the Greenbrier Clinic.  Routinely our billing department will submit your claim electronically within days of your clinic visit. Historically, insurance companies will process your claim in 45 days or less. 

The Greenbrier Clinic has reluctantly had to adopt this new financial policy in order to expedite the patient’s portion for services rendered. This is a continuing and rapidly growing problem and for years the clinic has refrained from implementing such a policy but to remain competitive and a leader in the industry we must change.