As a courtesy to our patients, we are happy to help you complete and submit medical claims to your primary and secondary insurance, including Medicare.
Insurances that both Stoughton Hospital and Dr. Rogerson are in-network with are: WPS, WEA (through Alliance), GHC (limited- call our office for clarification), Worker’s compensation, Medicare, Medicaid, the Alliance and Physicians Plus (limited- only PP+ members of Stoughton Hospital, Stoughton School District, and State of Wisconsin employees through December 2014 only). In 2015, Dr. Rogerson will continue a limited PP+ contract with PP+ members of Stoughton Hospital and Stoughton School District. Dr. Rogerson is in-network with Tricare, however, Stoughton Hospital is not.
Dr. Rogerson is an out-of-network provider for: all HMO point-of-service (POS) plans, Anthem Blue Cross Blue Shield, United, Cigna, Humana, and Aetna but often sees patients with these insurances. If surgery is necessary, you may be required to pay a portion of the surgical fees prior to your procedure. Please contact our office for clarification. Stoughton Hospital is in-network with Anthem Blue Cross Blue Shield Preferred HMO/POS, Blue Access, and Blue Traditional plans, United (not medical assistance), Cigna, and Humana insurances. Aetna claims often process through Health EOS. All surgical patients should get prior authorization for both surgeon and hospital fees prior to proceeding with surgery.
Managed Care Plans (HMO/PPO)
Many patients belong to managed care plans, such as DeanCare, GHC, Physicians Plus, or Unity. Generally, these organizations are designed to exert greater control over the use of medical care. Therefore, it is important that you have a clear understanding of the requirements and procedures of your plan. For example, most plans require that a primary care physician (PCP) refer you for specialty care and ancillary services (x-ray, lab, physical therapy, braces, etc.). You also may be required to obtain ancillary services from specific facilities.
Managed care plans have a wide variety of procedures that patients are required to follow, and each plan’s requirements vary. If you have a point-of-service option, you may be allowed to see a specialist outside the plan by paying a copayment. A recent law passed in Wisconsin states that can continue to see your current physician if he leaves your managed care plan, up to the end of your plan year. You may want to discuss this with your plan’s administrator. Make sure you understand and follow your plan’s rules carefully; otherwise your plan may reduce or deny payment of services.
Many insurance companies and managed care plans have co-payments (co-pays). In most situations, your insurance card will indicate if a co-pay is required. If your card does not show whether you owe a co-pay, please call your insurance provider.
Like most clinics, our clinic requires that you pay your co-pay at the time of your appointment. Please give your co-pay to our receptionist when you check in. You may utilize Mastercard, Visa, or cash for this payment.
Please note that our clinic welcomes Medicare assignments. If you carry an HMO secondary insurance, you may have difficulty seeking medical care outside their closed panel of doctors. We would still be happy to treat you if you are willing to pay the 20% copay that Medicare does not cover. You may utilize Mastercard or Visa if you desire.
No Insurance/Self Pay Patients
In these situations, payment in full is requested at the time of service and 50% of surgical fees are due 1 week prior to your procedure, unless alternative payment arrangements are made in advance with our office. Our practice will send you a statement for the remaining 50% surgical fee balance, and you are responsible for payment within 30 days.
If you have an insurance policy that provides income to you while you are disabled, we can assist you with the forms. Our office staff will go through these forms with you, as there may be areas of the forms that you need to fill out. Our clinic will mail these forms within three to five working days. Please allow us enough time to process these completely.
A Special Note About Our Functional Medicine Practice
Functional Medicine Financial Policy
For the Functional Medicine aspect of our practice we have instituted a different financial policy. We have found that insurance companies do not reimburse practitioners at a reasonable rate for preventive/ wellness services that are provided with Functional Medicine. Rather, insurance is heavily invested in reimbursement for more conventional health care services such as prescription medications, physical/occupational therapy, and surgical procedures.
Our Functional Medicine evaluation and treatment approach focuses on finding and treating the underlying upstream causes of your symptoms and is very time intensive. An initial Functional Medicine visit is 60-90 minutes of one-on-one time with a practitioner and additional time is spent researching and creating an individualized treatment plan. Therefore, we will not bill insurance directly and cash or check payments will be required at the time of service. We are currently unable to provide Functional Medicine services to Medicare/Medicaid patients.