Physicians place their completed form in the “To Be Done” box.
Some physicians will have a bill prepared for the document already.
For any bills that are sent, print in the top right corner “Billed and sent via (fax/mail/medi express)” and the date. If the bill was given directly to the patient, indicate that. This makes it much easier to track when and where the bill was sent.
The physicians frequently reduce the amount they will bill the patient and that is at their discretion. Lawyers, insurance companies, and any other 3rd party are always billed at the BCMA rate. Sometimes the insurance companies will indicate the maximum they will pay for a request.
The list of uninsured services is as follows:
|
Fee Schedule for Uninsured Services |
Plan X Fee Guidelines |
Clinic Standard Rate |
|
Clinical Services | ||
|
Complete physical exam |
149.00 |
|
|
Office visit |
69.10 |
|
|
Missed appointment – regular appointment |
69.10 |
|
|
Missed appointment- physical |
149.00 |
|
|
Injection – subcutaneous or muscular |
21.45 |
|
|
Forms and Notes |
|
|
|
Insurance form - long |
320.00 |
|
|
Insurance form – short |
153.00 |
|
|
Occupational fitness assessment form |
149.00 |
|
|
Other miscellaneous forms or notes |
n/a |
|
|
Physical fitness exams for schools, camps, etc. |
66.10 |
|
|
Sick note |
39.15 |
|
|
Industrial and Insurance | ||
|
Driver’s medical exam and report – non-patient |
183.00 |
|
|
Driver’s medical exam and report – patient |
183.00 |
|
|
General insurance exam |
188.00 |
|
|
Medical Legal |
|
|
|
Simple form/letter on patient condition |
149.00 |
|
|
Medical legal letter/form (short, factual) |
320.00 |
|
|
Medical legal report (includes symptoms, history, records, diagnosis, treatment, results, and present condition) |
958.00 |
|
|
Medical legal opinion (report plus expert opinion) |
1,602.00 |
|
|
Review of EMR records (15 min) |
89.50 |
|
|
Photocopying per page (first 10 pages) |
1.45 |
|
|
Photocopying per page (each additional page after 10 pages) |
0.30 |
|