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Insurance & Billing

Insurance Issues

We understand that financial and insurance issues can be stressful and confusing for cardiac patients. We want to do everything possible to ease your financial worries so that you can concentrate on staying well. As a Memphis Heart Clinic patient, you have the added advantage of dedicated staff members who work to ensure that you receive your full insurance benefits. We don’t want you to ever get over-whelmed by insurance paperwork. Simply call the Memphis Heart Clinic Billing Department, and we will assist you. Our Billing office number is 901.753.5440.

With the monumental changes in the healthcare system over the last few years, both patients and healthcare providers now carry a greater burden in understanding and complying with guidelines outlined in individual insurance plans. Patients who do not follow the guidelines of their particular insurance coverage may be responsible for payment of fees and services.

The following is a list of basic plan features and questions patients may ask themselves regarding their healthcare benefits.

Plan Features	Average to Good Plans
Yearly Deductible. How much of your own money must you spend on doctor bills before the healthcare plan begins to pay?	$100 – $300 per person
Annual Coinsurance Limit (Maximum Out-of-Pocket) . The coinsurance limit is the cumulative amount of your 10% to 30% copayment for covered expenses beyond the deductible. How much in total you must pay before your insurance pays 100%?	$1500 – $2500
Copayment . How much must you pay each time you visit an HMO or PPO healthcare provider?	$10 – $25 per visit
Prior-Authorization. Is prior-authorization or referral required for visits, radiology, lab, chemotherapy, or surgical procedures?	None or some
Choice of Medical Service Provider . Can you pick your own doctor or must you use a provider within your plan group?	Any or a wide choice within a network.
Second Opinions. Are second opinions covered?	Yes
Hospital costs covered. What share of hospital costs will the policy cover?	All (After deductible)
Prescription Drugs. How much do you have to pay for prescription drugs?	$10 – $25 or 80% after deductible
Lifetime maximum. If sick or injured several times, or have a long-term illness, what is the cap on total benefits the policy will make?	Unlimited or $1,000,000
Home Care Visits. If a nurse needs to see you at home, how many visits will the policy pay for?	Unlimited

Living Without Benefits

For cardiac patients who are not covered by an insurance plan, financial services and patient assistance programs are available on a local, regional and national basis. See Table A for a list of some of these resources and entitlements. These services include but are not limited to Medicaid/Tenncare Program, but also include programs such as patient drug assistance programs sponsored by virtually every major pharmaceutical company.

TABLE A

Agency/Organization	Resources/Support Available
Social Security Disability Insurance Apply at local SS office. 800-772-1213 www.ssa.gov/disablility	Pays benefits to disabled individuals who are “insured” meaning they have worked long enough and paid social security taxes.
Social Security Income Apply at local SS office. 800-772-1213 www.ssa.gov/disability	Federal income designed to help disabled people based on financial need.
Tenncare Bureau 800-669-1851 www.state.tn.us	Medical coverage available for low-income families and uninsurable individuals.
Veteran’s Health Administration 877-222-VETS (8387) www.va.gov	Provides a broad spectrum of medical, surgical, and rehabilitative care to enrolled veterans.