DSG: Davenport Surgical Group

• phone: 563.823.9300
• fax: 563.823.9330
• Suite 302 1228 E. Rusholme Street
• Davenport, IA 52803

Davenport Surgical Group, P.C. Billing Guidelines

Please, always bring your insurance card to every office visit!

Payment for services and products provided by Davenport Surgical Group, P.C., is the responsibility of the patient receiving them and/or their legal guardian. Payment is expected at the time services are rendered unless specific alternative arrangements have been made.

We realize that today's health insurance environment is complicated and sometimes confusing. Davenport Surgical Group, P.C., maintains a specialized staff that assists patients with obtaining their just benefits from their insurance companies. Patients are responsible for providing to us the information we need to assist them.

• When you provide us with the necessary information, we will file your insurance claim for you, if you pay your co-pay and deductible amounts at the time of service. An additional $5 will be added to your bill if co-pay/deductible is not paid at the time of service.
• We must have your insurance card in order to schedule you for a procedure or surgery. We will seek to obtain "preoperative certification" from your insurance company (if required) once we have your insurance card.
• If a dispute arises with your insurance company regarding coverage of services we provided, we will (with your permission) supply whatever records your insurance company requests to justify your claim for benefits1 if you will discuss your coverage difficulties with the Health Benefits Manager at your company and/or the appropriate customer service representative at your health insurance company.
• If your health insurance/company fails to appropriately respond to your claim within 30 days, we will request an expedited review of our claim, if you will discuss coverage difficulties with the Health Benefits Manager at your company and/or the appropriate customer service representative at your health insurance company.
• If your insurance company still fails to respond to your claim after an additional 45 days, a total of 90 days, we will directly charge the patient of legal guardian for the services rendered. We will expect payment in full within 30 days unless specific alternative arrangements are made.
• Balances at $100 or below must be paid in full
• Balances over $100 can be set up in 10 (ten) equal payments over 10 (ten) months.
• Balances not paid after 2 statements or payment plan set up will be sent to collections.
• Additional charges will be added to your bill for collection fees, lawyers fees, court costs as pertinent.

We accept Medicare assignment. We are participating providers with Blue Cross/Blue Shield of Iowa and Illinois, John Deere Health Insurance products (except John Deere Premier), and numerous other PPO's in the area. Health Insurance benefits vary widely among these companies and their numerous policies. Although we try, we are not always able to anticipate a particular decision your company might make regarding coverage of a service we provide you. Davenport Surgical Group, P.C. is not an Illinois Medicaid Provider.

Davenport Surgical Group, P.C., may not be able to resolve your disputes with your insurance company if:

1. Your insurance company does not cover the particular services or products we provided to you.
2. You were not covered by the insurance company at the time you received services from us
3. Your insurance failed to approve or "pre-certify" and operation, procedure or other services you received from us.
4. Your insurance company does not include our surgeons on their list of preferred providers.

We want your experience and association with Davenport Surgical Group, P.C., to be as pleasant as possible. We strive to provide high-quality, compassionate services to our patients. In addition, we try to treat all patients with dignity and respect. We realize that extenuating circumstances arise during periods of serious illness. We know that flexibility may be necessary at such times. Please do not hesitate to discuss your personal circumstances with us or ask for clarification of any of our payment policies at any time.

Genesis:

Please confirm that your health insurance provider has Genesis as a preferred provider. If receiving anesthesia, also confirm that Analgesia & Anesthesia is a preferred provider. All anesthesiologists at Genesis are a part of this group. If you have further questions regarding Genesis anesthesia or Genesis coverage please call the Genesis Insurance verifier at (563) 421-6816 Monday through Friday, 8am - 4pm.

¹ Charges for copying, preparing, and mailing record could apply (↑back to text)

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