INSURANCE LIST AND PAYMENT POLICIES*

Appointments (618) 277-3197 Exchange (618) 277-3214 E-MAIL The Country Doctor

AARP (Medicare Supplement)

Aetna

Blue Cross PPO, any state (NOT THE HMO; Blue Cross HMO = Self Pay)

(Fully Credentialed on Missouri Blue Cross PPO, including for employees of Dierburgs, Harts, and Schnucks)

Cigna

CMR

First Health, including mailhandlers and CCN

GEHA

GHP (not Advantra)

Healthlink PPO and HMO

(including in network for Memorial Hospital Employees and St. Elizabeth's UMR Employees)

HFN

Medicare and some Medicare PPOs

Meritain/Egyptian (Healthlink subcontracted)

We accept Medicare assignment

(NOT Medicare Complete HMO, NOT Advantra, and Not Essence)

UMR (Healthlink subcontracted)

 

We are out of network for all Medicaid, Harmony HMO, Illinois All Kids, Healthconnect, or other state Medicaid plans.

 

Mercy (allows Memorial Hospital Admissions)

Pyramid (Medicare PPO)

PHCS (Private Healthcare Systems)

Sterling Plans (Medicare PPO)

Unicare

United Health Care

Tri-Care Standard and Tricare for Life as a Medicare supplement (in network)

 

If your insurance plan is not listed or you have insurance that has expired, then you will be a self paying patient, meaning you will pay the full visit fee at the time of the visit. For the in network plans and workers compensation, the Country Doctor will file a claim for each patient. Motor vehicle accident patients and self paying patients will need to pay cash or credit card for any visit costs at the time of each visit. Third party insurance is not accepted accidents, such as Country Companies, State Farm, USAA etc.

 

We accept a limited group of self paying patients. Self paying patients, unless prior approval has been obtained, will need to pay by cash or credit card at the time of the visit. Some self pay visits will be styled similar to an acute care visit, meaning the self pay patient may be a one time visit and may not exist to establish long term care.

 

We see patients at both Belleville Hospitals and in the outpatient setting in the office. We do not send our established patients to hospitalists, who are inpatient-only physicians and who will not see you for follow up outside of the hospital setting.

Please visit our RECORDS REQUEST & NEW PATIENT FORMS for our new patient forms and old records request form. You are a new patient if you have never be seen in the office for a visit or if you have not been to an office visit within the last three years.

• The Country Doctor is the first St. Clair County practice to publish its common fee schedule.

The established visit for an insured patient usually is less than $100, with the patient responsible for the insurance-required copayment ranging from $10-$50, not including any deductibles or laboratory fees. Copayments, deductibles, and any other other fees are due at the time of the appointment. A valid insurance card must be presented at each appointment. This arrangement is part of your contract with the insurance company. If you fail to provide us with the correct insurance information, your claim is not paid by insurance within 45 days of the visit, and/or you have insurance that has been terminated, then you will be responsible for the balance of a claim at the full visit cost at self-paying patient rates.

Having an insurance card does not guarantee coverage of your care by the insurance plan. Patients must verify that each insurance plan is active by calling their appropriate insurance company. Additionally, some insurance companies require that you choose a primary care provider. It is the patient's responsibility to choose a primary care provider, prior to receiving care as a new patient. If you do not have Dr. David Mitchell listed on your card, then you may be responsible for any assigned costs from the insurance company, including the full visit cost. We do not accept capitation, and simply listing Dr. David Mitchell on your insurance card does not establish care or any doctor-patient relationship. Until you are seen for a paid visit in the office, you are not an established patient.

Please note that 98% of our patients are high-quality patients. To the less than 2% who attempt not to pay their bills, this payment policy has been created. This payment is based on the standard Metro East medical practice standards:

• Payment is due at the time of the office visit for copayments, deductibles, and Self Paying Patients.
• Cash is the preferred method of payment
• Checks are the second preferred method of payment. If you bounce a check, future visits will need to be paid by cash or money order. Bouncing a check requires a $30 fee, in addition to the already due amount. You may be reported to a credit agency, collections agency, and/or the Illinois State's Attorney for writing checks that are returned with insufficient funds.
• Mastercard, Visa, Discover, and American Express are acceptable forms of payment, but the credit card company charges 3% - 4%.
• Self pay patients, unless they have prior approval, will need to pay all fees in cash or credit cards. Prepayment may be required for self paying patients by phone.
• People who do not show up to a visit may be charged at least a $30 no show fee, which is why our no show rate is less than 1%.
• In the event that part of a missed copay, percentage copay, or deductible is billed, the amount must be paid within two weeks of the billed date. If the due bill is not paid within two weeks of the the billed date or if the fee is billed twice, a billing fee will be assessed.
• If a new or established patient attempts not to pay the copayment at the time of appointment, the patient may or may not be rescheduled.

The amount a physician can charge for copying medical records in the state of Illinois is regulated by Illinois General Assembly Senate Bill 721. The Country Doctor, Ltd. follows the fee schedule established by state law.

Patients must be seen in the office for medication refills, referrals, antibiotics, narcotic/benzodiazapine medications, and paperwork, such as the FMLA, disability forms, and work excuses. There may be a fee for paperwork completion.

 The Country Doctor, Ltd.

2310 Country Road

Shiloh, IL 62221-2570

Voice (618) 277-3197

Exchange (618) 277-3214

E-MAIL The Country Doctor

Website created by Dr. David Mitchell on his home-built, Power Macintosh Computer