Co-payment and Insurance Deductibles
Health insurance contracts require patients to cover their share of costs, which includes co-payments and deductibles. These payments are part of your agreement with your insurance plan, and our office is obligated to collect them. Federal law also requires collection of these amounts for Medicare patients, and waiving them is considered fraud.
To remain in compliance, Idaho Arthritis Center requires all co-payments and deductibles to be paid in full at the time of service. If a balance is left unpaid, it must be resolved before your next scheduled visit can take place. Appointments may be delayed or rescheduled until prior amounts are paid in full.
No-shows
We understand that schedules can change and sometimes appointments need to be adjusted. To keep care accessible for all patients, we ask that cancellations be made at least 24 hours in advance.
Any cancellation made with less than 24 hours’ notice will be considered a no-show. A $50 fee will be charged for each no-show. Patients with two or more no-shows within a 12-month period may be subject to dismissal from the practice.
This policy ensures that appointment times remain available for patients who need timely access to rheumatology care.
Cash-pay policy
Patients may choose to be seen as cash-pay if they do not carry a government-sponsored insurance plan such as Medicare, Medicare Advantage, Tricare, or Medicaid.
For cash-pay patients, payment is due in full at the time of service. We offer a 15% discount when payment is made at the time of service.
This option allows patients without eligible insurance coverage to continue receiving timely rheumatology care while reducing out-of-pocket costs.
Switching Doctors
All physicians at Idaho Arthritis Center are board-certified and fully qualified in the practice of rheumatology. If you have a preference for a specific provider, please let us know at the time of scheduling your first visit and every effort will be made to honor your request.
To maintain continuity of care and to avoid unnecessary “doctor shopping,” requests to switch providers after care has begun will only be considered in special circumstances and must be approved by the physicians involved. In general, these requests are not granted.
The same policy applies to patients seeking to transfer care from another rheumatologist within the Treasure Valley. To ensure fairness and continuity, transfer requests will be carefully reviewed and may be declined if they are not medically necessary.
Exceptions to this policy may be considered if a patient has relocated to a new geographic area or if circumstances arise that make a change in provider the most reasonable option for all parties involved.
Insurances not taking
Idaho Arthritis Center is contracted with many insurance plans; however, there are some insurances we are not able to accept for new referrals at this time.
We are not accepting new patients with the following insurance coverage:
• Medicaid
• Tricare
• TriWest
• ChampVA
• Owyhee
• Molina
If you have one of the insurances listed above, please contact your insurance company for information on providers available to you.
Multiple services in one day
Multiple Ultrasounds or Ultrasound-Guided Injections in a Single Day
Some insurance plans may not cover more than one ultrasound or ultrasound-guided injection performed on the same day.
When multiple procedures are recommended, patients have two options:
• Complete all procedures during the same visit and sign an Advance Beneficiary Notice (ABN), agreeing to pay cash for one of the services if it is not covered by insurance.
• Schedule a follow-up visit on a different day to complete the additional procedure(s).
Traditional Medicare plans typically cover multiple procedures on the same day. However, Medicare Advantage plans often do not, and federal guidelines do not allow us to issue an ABN for these plans. In those cases, procedures must be scheduled on different days to ensure coverage.
Our team will review these options with you so you can make an informed decision about your care.
Labs
Frequently non-covered labs
Some laboratory tests are commonly ordered in rheumatology but are not always covered by insurance. Patients should be aware that they may be financially responsible for these services if their insurance plan denies payment.
Examples of labs that are frequently not covered include:
• Vitamin D
• Hepatitis Panel
• QuantiFERON-TB Gold (QFT)
When one of these tests is ordered, patients may be asked to sign an Advance Beneficiary Notice (ABN). An ABN is a form that explains the test being ordered, the possibility that it may not be covered, and the patient’s responsibility for payment if insurance denies coverage. Signing an ABN ensures patients understand the potential costs before the lab is performed.
We order these labs only when they are clinically important for diagnosis or treatment monitoring. Our staff can help answer questions and provide cost information when available.
Prior authorization for Labs
We do not complete prior authorizations for laboratory testing. If your insurance plan requires prior authorization for a lab test, please contact your insurance company directly for guidance on coverage and next steps.
Urinalysis
Sometimes your provider may order a urinalysis, which requires a urine sample collected in the office. If you are unable to provide a sample during your appointment, you may return to the clinic during open hours to complete the collection.
24-Hour Urine Collection: In some cases, your provider may order a 24-hour urine test. This requires collecting all urine over a full 24-hour period at home. Our staff will provide detailed instructions and the necessary collection supplies if this test is ordered.
Outside Orders
To help limit the number of blood draws, we can collect outside lab orders at the same time as your clinic labs. Please ask your outside provider to fax the order to our office at least one week before your appointment so we have time to review and prepare. You may also bring a printed copy of the order with you, as long as it includes all the necessary information.
Special Collections
Some lab tests require special collections. Things like: fasting, being collected at certain times of the day, special tubes, etc. Depending on what is ordered and what the results are, you may be asked to schedule an additional lab appointment to fulfill a requirement.
The most common requirement is fasting for 12-14 hours prior to having your blood drawn. If you are aware that you need fasting labs, coming fasted helps decrease the chance for a recollection.
Common examples of labs that may need fasting include: Cryoglobulins, Lipids, Cholesterol, LDL, HDL and VLDL.