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.

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Billing Procedures

Billing Procedures

We are always here to assist you, but we rely on you to provide us with current insurance information. Questions that arise regarding your specific insurance coverage are between you and the insurance company, and you should contact your carrier to resolve any difficulties. You will not receive a bill from our clinic until your insurance provider has processed your claim. If your insurance does not cover the full amount of the bill, you will receive a bill for the remainder of the charge. It is your obligation to pay or make payment arrangements to pay this portion within 14 days of receipt of the bill. If you believe your insurance provider handled your claim incorrectly, please contact your insurance provider directly.

Insurance Coverage

Stoughton Hospital accepts over 160 area insurance plans, including but not limited to those listed below. If your plan is not listed, please check your individual plan regarding coverage of services at Stoughton Hospital.

  • Alliance
  • Blue Cross Blue Shield
  • Cigna
  • Group Health Cooperative
  • Humana
  • Physicians Plus
  • Security Health Plan
  • Unity
  • United Healthcare
  • WPS

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.

Co-Payments

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.

Medicare Coverage

Please note that our clinic welcomes Medicare assignments. If you carry an HMO secondary insurance, you may have difficulty seeking medical care outside their 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 or payment arrangement within 14 days of receipt of the bill.

Disability Insurance

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.