Patient Acknowledgement of Financial Responsibility
- The patient (patient’s guardian, if a minor) is ultimately responsible for the payment of treatment and care.
-We will attempt to confirm your insurance coverage prior to your treatment. However, your benefits are a contract between you and your insurance company. As a courtesy, Manchester Care Clinic will attempt to file for payment from your insurance company.
-It is your responsibility to provide current and accurate insurance information, including any updates or changes in coverage. Should you fail to provide this information, you will be financially responsible.
-Patients are personally responsible for knowing and understanding their own insurance policy, including co-payment, deductible, eligibility, and coverage. If you have questions regarding your coverage, please call your insurance company directly.
-Verification of coverage is not a guarantee of coverage or payment. Actual benefits are determined by your insurance company upon receipt of the claim.
-Laboratory services are provided by AEL Laboratories/Access Labs/ Gravity Diagnostics. There may be additional charges for labs performed. Any questions about billing from the Lab provider are to be resolved by contacting the lab company directly.
-If deductibles apply, you will be expected to make a $75 deposit at the time of service or pay the copay listed on your benefits card.. We will bill any remaining deductible determined by your insurance company to you.
-Medicare Patient Certification and Assignment of Benefit. I certify that any information I provide, if any, in applying for payment under Title XVIII (“Medicare”) or Title XIX (“Medicaid”) of the Social Security Act is correct. I request payment of authorized benefits to be made on my behalf to Manchester Care Clinic LLC by the Medicare or Medicaid program.
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INSURANCES
We accept the following insurances:
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BlueCross BlueShield of any state
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United Healthcare
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Aetna
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Cigna
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Medicare
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UMR
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Tricare East
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Amerigroup
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Bluecare
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United Healthcare community plan
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Lucent
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Unfortunately we cannot take Cigna Healthsprings, AMbetter, Bright health, or Humana
Call the number on the back of your card if you have a question about insurance eligibility or you can call our office and we can help you with this 931-800-4622
QUESTIONS ABOUT YOUR BILL
Call 1-877-378-4644
What billing or insurance information will I receive?
​You will receive a copy of your bill. After your insurance has paid, we'll provide you with a monthly statement of your account.
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How long will it take to get things settled with the insurance company?
Generally, it takes from 45 to 60 days to obtain payment from an insurance carrier.​
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​Why am I getting bills from physicians?
​Each physician who provides professional services will send you a separate bill from his or her office. These physicians will include:
- your own physician
- other physicians who conducted tests and procedures
- consulting physicians chosen by your primary physician to read and interpret test results.
These physicians may include specialists in anesthesiology, cardiology, emergency medicine, nuclear medicine, pathology, radiology, or urodynamics. You will be responsible for paying these bills as well.
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​I received a notice that my insurance company has paid on my bill -- but I can't understand how they calculated their payment amount. Do you know?
​If we have received any such information from your insurance company, we'll be glad to share it with you. However, for answers to any questions about insurance payments, deductibles, or co-payments, you generally need to check with your insurance company.