INSURANCE LIST AND PAYMENT POLICIES*

8-4 M-F and Sat AM Appointments (618) 277-3197 Weekday AM Appointments and Exchange (618) 277-3214 E-MAIL The Country Doctor

AARP (Medicare Supplement)

Aetna HMO/PPO/POS/NAP/Medicare

Blue Cross PPO, any state (NOT THE HMO)

(In network for the St. Elizabeth's Hospital Blue Cross PPO*)

Coventry/Foreign Service/Personal Care

(Missouri Blue Cross PPO, including for employees of Dierbergs, Harts, and Schnucks)

Cigna HMO/PPO including Cigna Great West

Coventry

First Health, including mailhandlers and CCN

GEHA

GHP/CMR/PPO/HMO/POS/Carpenters etc. (not Advantra)

Healthalliance (Healthalliance subcontracts with Healthlink)

Healthlink PPO and HMO

(including in network for Memorial Hospital Employees)

HFN

Humana (does not allow Memorial Hosp. Admissions)

Medicare, Medicare RR, and some Medicare PPOs

 

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

 

UMR (Healthlink or UHC subcontracted)

Mercy (allows Memorial Hospital Admissions)

Meritain/Egyptian (Healthlink subcontracted)

Personalcare.org (state of IL)

PHCS (Private Healthcare Systems)

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

United Health Care

 

We are out of network for all Medicaid, Harmony HMO, Illinois All Kids, and Healthconnect.

 

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, 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 for motor vehicle accidents.

 

Please note that we are using two of the phone lines for appointments on weekdays. From 8-noon you can call 277-3197 or 277-3214 for appointments and general questions. After noon on weekdays, 277-3197 is the contact method for appointments and general questions. Messages are accepted at 277-3197 Monday-Saturday and will be returned during regular hours of approximately 8-4 M-F and 8-11:30 on Saturday.

 

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/debit card at the time of the visit. Some self pay visits will be styled similar to an acute care visit, meaning the self pay patients may be seen as a one time visit.

 

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 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 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.

For 2012, the total average premium for PPO insurance premium for a family of four is $19,500. Establish visits usually are less than a $100. Most of the premium money does not go to the doctor. Deductibles often are over $1,000 and as high as $10,000. We have no control over the cost of the deductible. The deducible and copayments are assigned by your insurance company. We accept no capitation from insurance companies and exist as a fee for service practice. The one way negotiation between insurance companies and our fee schedule means that most insured PPO patients get an average of 10% savings off our fee schedule.

Having an insurance card does not guarantee coverage of your care. 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 HMO or equivalent card, then you may be responsible for additional costs, 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. New patients are patients who have never seen Dr. David Mitchell or who have not been seen for at least three years.

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 policy 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, credit card, debit card or money order. Presenting a check that is returned for insufficient funds requires a $30 fee, in addition to the already due amount. You may be reported to 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%. A convenience fee may apply to credit/debit/HSA card use.
• Self pay patients, unless they have prior approval, will need to pay all fees in cash or credit/debit 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 may 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. 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