• Do both offices have the same billing department?

  
  Yes, both offices have the same billing department. The billing department is located at the Tigard office. The phone number for the billing department is 503. 968.6872. Please contact them if you have any questions regarding your account.
  

• Why did I get a bill?

  
  Our office is unlike most. We only send out statements once we have received an explanation of benefits from your insurance. Most doctors’ offices will send out statements to you to notify you that they have billed your insurance. Our office doesn’t do that. If you are receiving a bill from our office that means your insurance has denied or not covered the visit. The balance on the bill is your responsibility. If you feel that your insurance processed your visit incorrectly, please contact them for final determination regarding payment on your visit.
  

• Did you bill my insurance?

  
  Our office software system is set up to bill your insurance once a charge is incurred on your account. There are times, however, when the billing department will receive inaccurate insurance information. Thus, we are unable to bill your insurance. If you feel that your insurance was not billed it is a good idea to contact our billing department to review your account.
  There is a way to tell on your statement if we have billed your Insurance. If you look at the 2nd column from the left on your statement it says insurance date. If there is a date in that column, that date is the date which your insurance was billed. Our statements don’t tell you what insurance we billed. If you are questioning what insurance was billed, we suggest that you contact our billing department and they will further assist you.
  

• My bill says to “contact my insurance”, why do I need to do that?

  
  Your insurance is most likely requesting updated information from you. Normally, they will do this every year. Your insurance wants to make sure that they have the most current updated information on your account with them. They need to make sure that you don't have other insurance and that your address is correct. Unfortunately, this information must be received by them from you. This is not something that our office will be able to do for you. They must receive this information from you before they will process any of your outstanding claims.
  Another instance when you will see "contact your insurance" on your statement is when your visit has been vaguely denied. Your insurance did not give our office a reason why the claim was denied. The billing department suggests you contact your insurance to find out why your visit was not paid.
  

• Why can’t you re-bill my insurance if they processed my visit wrong?

  
  Unfortunately, if we re-bill your visit the insurance will normally duplicate it without reprocessing it. It is always best for you to contact your insurance and have them reprocess the visit on their end. Contacting your insurance is the only way to ensure that your insurance will reprocess your visit.
  There are instances when our office will need to re-bill your insurance. They are when diagnosis or procedure codes are changed or when your insurance is requesting chart notes.
  

• What is a referral? Why is it important?

  
  A referral is authorization from your primary care physician for you to come into our office for care. If you have a HMO plan you are required to get a referral or approval from your primary care before your visit to our office. Once your visit to our office is approved by your primary care office their referral coordinator will contact your insurance to let them know of the approval. Your insurance needs that approval from your primary care office before they will pay for any services in our office. It is suggested that you contact your primary care referral coordinator before your visit in our office. Delay in contacting them can delay or deny your referral.
  

• Do you bill 3rd party insurances?

  
  No, our office does not bill any 3rd party insurance. We will only bill your own medical insurance or your own motor vehicle policies. Please see our section on motor vehicle (MVA) questions.
  

• Why is signing the demographic sheet every year important?

  
  Our office requests that you fill out a new demographic sheet every year for our office to have current information in your chart. Your insurance also requests our office to get a new signature on file each year for billing purposes. If we don't have a valid signature on file your insurance could deny your visit leaving you responsible for the bill.
  

• What are your payment policies?

  
  Doctor's Family Clinic & Immediate Care is contracted with most of the insurance carriers in our area. Below are private medical insurances that Doctor's Family Clinic is contracted with:
  
  
  
  Below are private medical insurances that Physical Therapy is contracted with:
  
  
  
  ***Please note that the contracts above are subject to change without notice. Please contact our billing department at 503-968-6872 or your insurance company to verify benefits before coming into our office.
  Please note that we are not contracted with Medicare or the Oregon Health Plan.
  




Oregon Health Plan Questions

• Are you contracted with Oregon Health Plan?

  
  No, our office is not contracted with Oregon Health Plan or OMAP/OHP. We are not contracted with any plans under the Oregon Health Plan.
  

• Can I just pay in cash for my visit if I have the Oregon Health Plan?

  
  No, unfortunately it is against the law for us to collect monies for any health care services we provide to a patient who has the Oregon Health Plan. Oregon will not allow our office to collect money from you. The State of Oregon assumes when you are covered under any OHP plan you cannot afford your own private health insurance. This is why our office can't collect money from you.
  Please be aware that if you come into our office and do not let us know that you have OHP at the time of your service, our office will bill you for the services rendered. You will be treated as a self-pay patient.
  

• Where else could I go if I have Oregon Health Plan?

  
  We would suggest that you contact:
  Providence Urgent Care at 503-215-9900
  12442 SW Scholls Fy. Rd.
  Tigard, OR 97225
  
  Tuality at Aloha Urgent Care at 503-681-4223
  17175 SW TV Hwy #A
  Beaverton, OR 97006
  
  Please verify with either facility before being seen there to make sure that they do accept your particular OHP plan.
  ****If you have any questions about the above information please contact our billing department at 503-968-6872.
  

Medicare Questions

• Why don’t you see Medicare patients?

  
  Our office has found that we don't have a high volume of Medicare patients. Being a walk-in clinic only, except for physicals, does not provide the managed care that patient's with Medicare are accustomed to. Our office has had an opt-out contract with Medicare since April 2001 to current.
  

• What is the Medicare opt-out agreement?

  
  It is an agreement that our Doctors have with Medicare stating they will not bill or take assignment from Medicare. Under this agreement our office cannot bill Medicare.
  

• Can I come into your office with Medicare?

  
  You are welcome to come into our office for service. However, please be aware that none of the charges you incur will be covered by Medicare or billed to Medicare. You will be waiving all of your Medicare rights. You will be asked to sign a waiver stating you understand that we will not bill Medicare. You will also be asked for payment in full at the end of your visit.
  

• Can you just bill my supplement insurance before Medicare?

  
  No, unfortunately once you are over 65 it is our understanding that your Medicare insurance is primary. Your supplemental insurance is your secondary insurance. If we billed your 2nd insurance first they would deny the visit stating we have to bill the primary first. Your supplement insurance will require notification from Medicare before they will pay the claims and we can't bill them. Our office can't bill Medicare nor will Medicare accept the billing from you. Therefore, it would be beneficial for you to seek care from a medical facility that accepts both Medicare and your supplemental insurance.
  ****If you have any questions about the information above please contact our billing department at 503-968-6872.
  




Motor Vehicle Accident FAQ's

• What happens when you come into our clinic for motor vehicle accidents?

  
  You need to supply the front desk with your motor vehicle insurance. If you don't have this information you will be treated as a self pay patient. If you were a passenger when the accident happened please provide the motor vehicle insurance of the car you were riding in.
  Our clinic requests that you contact the motor vehicle insurance you gave us to set up a claim with them. If a claim is not set up with the motor vehicle insurance, they will not pay for any medical services. We would prefer you contact your motor vehicle insurance before your visit to our office.
  We will bill your motor vehicle insurance after your visit.
  

• Why don’t you bill the responsible party’s motor vehicle insurance?

  
  When you set up a claim with your motor vehicle insurance they will determine who the responsible party is and then whose motor vehicle insurance is responsible. Our office will bill your motor vehicle insurance; they will pay us and then request reimbursement from the responsible party's insurance.
  

• Can you bill my medical insurance for a motor vehicle accident?

  
  No, unfortunately the State of Oregon stipulates that we have to bill your motor vehicle insurance first before any other insurance is billed. If your motor vehicle insurance denies your claim then our clinic could bill your medical insurance. You will want to make sure that your medical insurance is one that our clinic contracts with otherwise our office will be unable to bill them.
  

• Why am I getting a bill for my motor vehicle claim the insurance should have paid?

  
  Our office bills the motor vehicle insurance as a courtesy. Our office allows your motor vehicle insurance 60 days from the billing date to pay for your services. After 60 days, our clinic will bill you for any amount that is not paid. It is then your responsibility to work with your motor vehicle insurance for payment.
  

• Is your office contracted with any motor vehicle insurances?

  
  No our office is not contracted with any motor vehicle insurances. This means any balance that is not paid for by your insurance will be billed to you.
  If you have any questions regarding any of the information above or have a separate question please contact the billing office at (503) 968-6872. They will be happy to assist you.
  




Workers Compensation FAQ's

• What happens when I come in for an on-the-job injury?

  
  When you come into our office we will ask you to fill out an 827 form. You will need to provide your employer's name, address and phone at the time of injury. You will also need to provide your demographics on the 827 as well. It will have you describe your injury, then make sure you sign your name where indicated. It is important that the information you provide on the 827 is current, and filled out entirely so there aren't any delays in processing your claim. If you have any questions when you are in the office about the 827 form, please ask the receptionist.
  After the 827 is filled out, you will be seen by one of the providers in our office. Then your chart and 827 is given to the billing office so they can locate the worker's compensation insurer for your employer. Once the worker's compensation insurance is located, the billing office sends the insurance, the 827, the HCFA (or bill) and a copy of your chart notes.
  

• Do you ever bill my medical insurance?

  
  Our office will bill your medical insurance only if your worker's compensation claim has been denied. You must keep in mind that our office can only bill medical insurances that we are contracted with. You will want to check with the billing office about what insurance companies we are contracted with. The billing office phone number is ( 503 ) 968-6872.
  

• What if my employer does not want to file worker’s compensation, can we bill them directly?

  
  Unfortunately, we can't do that. However, the employer does have the option of reimbursing the worker's compensation insurance for any claims totaling less than $500. If the employer opts to go this route, then the worker's compensation insurance will not put a "mark" against them for the on-the-job accident. An 827 still must be filed.
  

• Who is my attending physician?

  
  Your attending physician is the first physician that you saw for your on-the-job injury. If you wish to change your care to a different physician you have to fill out a new 827 form and check the box for changing your attending physician. This notifies the worker's compensation insurance of your change. You can only change physicians 3 times for one injury.
  If you are currently seeing a physician in our office but would like to change to a different physician within this office, you will still need to fill out a new 827 to change your physician.
  

• What is a MCO? Which MCO can we see in the office?

  
  A MCO is a managed care plan. Your Workman’s Compensation Insurance Adjuster will contact you by sending you a letter explaining that you have been enrolled in this organization. Once enrolled, you will need to follow the provider restrictions outlined in your specific letter.
  Most Providers at our office are part of the Caremark Comp. MCO. Those providers are: Benjamin J. Schwartz, M.D., Joel I. Bohling, M.D., Lisa Watts, D.O., Susan Yeh, M.D. and Christina Fyfe, N.P. If you are enrolled in the Caremark MCO, you must pick one of the above doctors as your attending Physician.
  

• What is the difference between an aggravation and palliative care?

  
  An aggravation occurs when there is a worsening of the accepted condition after a claim has been closed.
  Palliative care occurs when there is a temporary flare-up of an accepted condition after the patient has been deemed medically stationary.
  

Acknowledgment and Consent

Demographic Form

Health History

Notice of Privacy Practices

If you have any questions regarding any of the information above or have a separate question, please contact the billing office at 503.968.6872. They will be happy to assist you.