Insurance and
Billing Information

Insurance we currently accept:

• Blue Cross Blue Shield of Georgia (PPO, POS, HMO and Out of State Plans)
• United Healthcare (PPO & HMO)
• Aetna
• Amerigroup
• Cigna
• Coventry Healthcare
• Humana
• Tricare
• PHCS
• State Health Benefit Plan
• Great West – One Health Plan
• Southcare – Beechstreet
• Medicare (We participate in most Medicare Replacement Plans)
• AARP
• Medicaid
• Peach State Health Plan
• Wellcare
  
  

Please bring your insurance card with you. It is very important for you to bring your current insurance card each visit and to inform us if there has been any change in your coverage or in your address. As changes may occur in the plans that we accept, please verify our acceptance at the time you make an appointment.

Heart and Vascular Care will make every effort to verify your coverage prior to your appointment, yet we cannot guarantee coverage of services by your insurance company.

New Patients

We welcome new patients for consultations with our providers, for diagnostic evaluation, and for medical treatment. You may contact us directly or through a referring physician. Please make sure to forward copies of your medical records from other physicians before your first appointment, which will be set for the earliest time and date possible. New patients to our practice and patients following up from hospital treatment can complete our new patient paperwork prior to their appointment. Please print the New Patient packet from the link below and bring the completed forms with you to our office. Please arrive approximately 15 minutes prior to your appointment to allow for parking and timely arrival. On your first appointment, please bring your medical records (or make sure that we have received them, a list of all medicines you are presently taking (include all herbal and over the counter medication) and your health insurance card(s). Please bring your insurance card(s) and a photo ID.

Established Patients

Once a year we make new copies of our patient’s current insurance card(s) and photo ID. Please be sure to bring them to your first appointment of the year. At that time we will also need to update a few forms. If you would like to bring those forms to your appointment please print and bring in the forms listed under “Yearly Update Paperwork”.

Medical Record Request

If you need to request or release medical records with our office please print and fill out the medical record release form. Once completed submit it to our office via mail, fax, or drop it by any location for processing.

Billing Inquiry

Heart and Vascular Care’s Business Office is pleased to file insurance claims for our patients. To ensure accurate filing, please do the following: · Prior to your appointment, review your insurance carrier’s requirements for pre-certification/pre-authorization. Failure to follow your carrier’s stated protocol could result in reduced benefit payments. · Present your insurance card at the time of registration. Regardless of the Heart and Vascular Care location you received care, if you have questions about your bill, please call the Billing Department at 470-533-0037 Monday through Friday between 8 a.m. and 5 p.m. EST.

No Surprises Act

Effective January 1, 2022, the No Surprises Act, which Congress passed as part of the Consolidated Appropriations Act of 2021, is designed to protect patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities, holding them liable only for in-network cost-sharing amounts. The No Surprises Act also enables uninsured patients to receive a good faith estimate of the cost of care.

Billing Disclosures - Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care–like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Additionally, Georgia law protects patients from surprise medical bills for: (i) covered emergency medical services provided by an out of network provider or at an out of network facility and (ii) covered non-emergency services from an out-of-network provider. This prohibition on balance billing does not apply if the covered patient chose to receive non-emergency services from an out-of-network provider and provided oral and written consent.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

Additionally, Georgia law states that these protections require the patient only to pay their in-network cost sharing-amount. These protections apply to patients with coverage through a state healthcare plan, managed care plan or a third party that opts into the prohibition from balance billing.

When balance billing isn’t allowed, you also have the following protections:

• You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
• Your health plan generally must:
• Cover emergency services without requiring you to get approval for services in advance (prior authorization).
• Cover emergency services by out-of-network providers.
• Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

If you believe you’ve been wrongly billed, you may contact:

• The U.S. Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227) or visit cms.gov/nosurprises for more information about your rights under federal law.
• The Georgia Office of Commissioner of Insurance and Safety Fire at (800) 656-2298.
  
  

Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment and hospital fees.
• Make sure your healthcare provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

Get More Information

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises or call 1-800-MEDICARE (1-800-633-4227).