Insurance
We will submit charges to any insurance plan with which we participate. Insurance co-payments are due at the time of your visit. For individuals not covered under such an insurance plan, we request payment for office services be made at the time of your visit.
Managed Care plans may require you to select a doctor as your Primary Care Physician (PCP). This should be done prior to visiting our office.
If you have a billing or insurance question, you may reach our billing department at (973)239-5211 or by
e-mail at billing@townmedical.org
We Participate in the following:
- Affiliated Physicians Health Plan (MEWA)
- Aetna
- AmeriHealth
- Atlantic Health (by Coresource)
- Beech Street (includes PPONext)
- Blue Cross/Blue Shield 1
- Choice Care Humana Network
- Cigna
- Devon Network
- Empire BC/BS 2
- Health Net
- Horizon BC/BS of NJ
- Horizon NJ Health
- Inter Group Services Corp.
- Medicare
- MultiPlan Network
- Oxford 3
- PHCS Network
- Qualcare PPO
- United Healthcare 3
- Wellcare Medicare
1 Out of state plans with suitcase logo-claims will be sent to Horizon BCBS of NJ.
2 We do not participate with Child Health Plus,Senior Plan Direct, Direct Pay POS,
MediBlue HMO,
MediBlue PPO and MediBlue Smart Value.
3 We do not participate, but will submit as out of network providers.
Hospital Care
Patients who require hospitalization will be cared for by our affiliated hospitalists. Hospitalists are physicians who specialize in the care of patients in the hospital. Because they concentrate their patient care efforts at the hospital, they can be more available to closely monitor our patient's status during their stay, and can follow-up with test results as they become available. Our hospitalists will notify your doctor when you are admitted, and will forward all appropriate information to our office at the time of your discharge from the hospital.Commonly Asked Billing Questions
Q. What is an insurance copayment?A. A copayment, copay or encounter fee is the amount of money your insurance plan requires you to pay at the time of your visit.
Q. Am I required to pay a copayment every time I visit the office?
A. Generally,our staff will collect a copayment every time you see the doctor for an office visit. Insurance company rules regarding copayment collection for lab work, immunizations, office surgeries, etc. vary depending upon the type of insurance involved.
Q. My insurance plan has a deductible and co-insurance. How will I know what I am required to pay?
A. Any insurance plan deductible and co-insurance is the patient's responsibility. You will receive a bill from us after we have received your insurance company's payment. You should also receive an Explanation of Benefit from your insurance company which will indicate the patient's financial responsibility.
Q. Why did I receive a bill when I paid my copayment at the time of my visit?
A. There are a number of different reasons you could receive a bill from us in addition to your copayment:
- Some insurance plans require a deductible for laboratory services, immunizations, minor surgical procedures or hospital visits, etc. In that case, you would be responsible for any charges put toward your deductible.
- Not all insurance plans cover preventative care services, ie annual physicals, immunizations, EKGs. Therefore, any charges for these services would be the patient's responsibility.
- Some insurance plans require you to select a primary care physician. If you have not done this, your insurance company will consider your visit to be "out-of-network"even though we participate with your plan.
- Your insurance plan may not cover visits for obesity, pre-employment exams, school or sports physicals, cosmetic removal of moles and lesions, or any other diagnosis they deem not medically necessary.
Q. Both my spouse and I work and have dual coverage through our employers. Why can't I choose which plan I want to use?
A. The insurance industry developed an industry wide agreement which determines which plan pays first. Generally, the plan covering the patient as the employee pays before the plan covering the patient as the dependent spouse. Therefore, your employer's insurance plan would be primary on you and the coverage through your spouse's employer would be considered secondary.
Q. Which plan would be primary for our children?
A. The order of benefit determination depends upon the birth date (month and day) of the parents. The plan covering the parent whose birthday occurs earlier in the calendar year is considered primary. For example, if the child's mother was born on March 27th and the father was born on August 7th, the mother's insurance plan would be primary.
Referrals:
If your insurance requires a referral for testing or specialist consultation, please allow 3 business days for the referral to be processed.Patient Forms:
We provide all of our new patient forms online so you can complete them in the convenience of your own home.1. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download it for free.
2. Click on the necessary form, fill in the required information and then print it out.
3. Please bring your printed and completed forms with you to your appointment and save time on your visit!
