(click on a question below to see the answer)

1) Does CCMC accept my insurance?

We participate with most major insurance carriers such as Medicare, BCBS of MI, PHP, and Medicaid. There are many commercial insurance carriers and participation varies. We strongly recommend that you contact the customer service department at your insurance company and verify coverage before services are provided. The phone number for customer service is usually found on the back of your insurance card.

2) What services are covered under my insurance policy?

Because of the diversity in insurance policies/coverage, we are unable to know what is specifically covered under your particular policy. We strongly encourage you to contact your insurance company directly to clarify your coverage.

3) Can I get a copy of my medical records?

Yes, after signing the appropriate authorization. We have a company called Smart Copy that comes to our office once a week and copies requested records. Smart Copy charges a base fee plus a per page fee.

4) When I have a problem or question can I talk to my doctor?

All patients are encouraged to call with questions they have about their medical problem(s). However, it would be most unfair to the patients that are being seen in the office if the doctor were to leave to answer every telephone call. The clinical office staff has been trained to answer many of your questions. If they’re unable to answer your question they will relay your information and question to the doctor and your call will be returned or answered by mail at the earliest opportunity.

5) My doctor has ordered fasting lab tests, what can I eat or drink?

You should not eat anything after 10:00 p.m. the night before having your blood drawn. The only liquid you can drink is water; in fact drinking some water helps keep your veins plump and makes drawing blood easier. You should take all your medication as usual and brushing your teeth is fine.

6) How do I get my medication refilled?

Your provider will write your prescription with the number of refills he/she feels is safe. With your last refill you must make an appointment with your physician for a medicine refill check-up two weeks before your medication runs out. At the time of your appointment your provider will review your medications and write for the appropriate refills. Medication refills will not be authorized over the phone.

7) If my provider wants me to see a specialist and I need a referral how soon will I hear from CCMC’s referral department about the date and time of my appointment with the specialist?

Our referral department will handle emergency referrals first. All other referrals will be completed in the order they are received. You should receive information about your referral from either CCMC or the specialist office about a week after the referral was ordered.

8) What portion of Medicare covered services am I responsible for?

A $135.00 deductible is accessed each calendar year, beginning on January 1. Medicare tracks it, and beneficiaries are notified on their Medicare Summary Notice, when his/her deductible has been met.

Medicare pays 80% of the approved amount of services that are covered benefits, under the Medicare program. The remaining 20% is accessed in the form of co-insurance, that is the beneficiary’s responsibility.

9) Are there any screening procedures covered by Medicare?

Medicare does allow for some screening procedures. For those procedures that are allowed, there are time frequency requirements that must be observed, for the service to be covered.

PLEASE NOTE: A physical examination is covered ONLY if it has been within 6 months that you become eligible for Medicare benefits. All other complete physical examinations are not a benefit under the Medicare program.

PSA (prostate specific antigen) Test
Beneficiaries aged 50 and older, are entitled to one (1)
screening exam every 12 months.

Pap Smears, Pelvic and Breast Examinations
Beneficiaries are entitled to one (1) screening exam every
2 years.

Beneficiaries aged 40 and older, are entitled to one (1)
screening exam every 12 months.

Occult Blood Test
Beneficiaries aged 50 and older, are entitled to (1) screening
exam every 12 months.

Colonoscopy Examination
Beneficiaries are entitled to one (1) screening exam every
10 years.

10) What is the difference between a Physical and an Office Visit?

A physical – also known as a complete physical or preventive medical exam – is a thorough review of your general well-being.  The clinician will review your known medical problems, perform a complete physical examination and make recommendations concerning your health.  This may include general recommendations regarding diet and exercise, age appropriate immunizations and cancer screening exams such as a pap test, prostate exam or breast exam, and screening lab work.  Ongoing chronic medical problems can be addressed as long as the condition is stable and does not require a change in treatment or additional tests.  Prescriptions, including refills, are generally not included as part of the physical exam.

An office visit is an appointment to discuss new or existing problems.  The questions and exam will focus on the problems discussed.  This may include prescribing medications (including refills), ordering additional tests like lab or x-ray, in-office procedures such as an EKG, referrals to specialists, or discussing other treatment options.

Occasionally, you may be seen for both a physical AND an office visit on the same day.  This means the encounter satisfies the requirements for both types of visits during one appointment.  For example, if you schedule a physical but also discuss an additional problem that requires evaluation and treatment – either for a significant new symptom or a notable change in an existing condition requiring a new treatment plan.  In this situation, you would be billed for both a physical and an office visit during the same appointment, which could include an additional co-pay.

Please note that our billing department bills exactly what your clinician has reported for your visit.  The billing department cannot change the codes before reporting them to your insurance company.  They must reflect the services you received during your visit.  Your insurance company determines what is and is not covered by your policy.  Please call them if you have any questions about your coverage.

We hope this information is helpful.  We want to provide you with the highest quality medical care possible.  If you have any questions or have a concern about what today’s visit will be billed as, please discuss it with your clinician at the beginning of today’s visit.

© 2011 Clinton County Medical Center