Insurance & Billing

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All payments being mailed should be sent to:

Kosciusko Medical Group
Attn # 4855K
PO Box 14000
Belfast, ME 04915-4033

For credit card and debit card payments, please call (574) 372-7617 (574) 372-7617 .

For each visit to our offices, please be prepared to bring the following information with you.

  • Your complete address and phone number.
  • Insurance Cards
  • Photo ID
  • Emergency Contact Information

Please know that with each visit you will be asked to verify this information. Please let us know if you have any changes.

Before you are seen by one of our physicians, you should know your policy coverage, copay amount, deductible, and service benefits such as immunizations and well visits. We are happy to file your claims to the insurance company. Please realize many insurances do not cover full amounts, and you may owe for a portion of your service. Payment is due at the time of service, and if needed, we will work out payment plans.

If you have any questions, our business office will be happy to assist you. You may reach us at (574) 372-7617 (574) 372-7617 . The business office hours are 8:00am – 4:30pm Monday through Friday.

Kosciusko Medical Group accepts the following insurance plans:

Advantage 360 (PPO Only)
Aetna Medicare
Ambetter/Market Place
Anthem Healthy Indiana Plan (HIP)
Anthem Medicare
Anthem Medicaid/HHW, HCC
Anthem Pathways Market Place
Black Lung
Care Source/Medicare Advantage
Cigna Healthcare (PPO only)
Community Health Alliance (CHA) Must have Lutheran Preferred Network or logo on ID card
Coventry Healthcare/First Health
Encore Network
Goshen Preferred
Humana Choice Care PPO
Humana Medicare PFFS, PPO and HMO
IU Health Network (PPO, Medicare & Market Place)
Lutheran Preferred
Managed Health Services (MHS Hoosier Healthwise Hoosier Health Connect HIP)
MdWise Hoosier Care Connect
MdWise Excel Health Indiana Plan (HIP)
MdWise Excel Hoosier Healthwise
MdWise Connect (Market Place)
MdWise Total Health (Specialists Only)
Medicaid, Traditional
Medicare Part B, Traditional
Parkview Health Plan – Signature Care
PHCS/Multi Plan
Physicians Health Plan (PHP- Market Place)
Railroad Medicare
Sagamore Health Network
Three Rivers Preferred
Tricare Prime (managed care program)
United Healthcare PPO Products
United Healthcare Exchange (Market Place) Until 1/2017

List current as of June 1, 2016.

The above list is not meant to be a complete list but rather as a guide for you. Patients are responsible to verify that their physicians are in network with their insurance plans. Not all of our physicians participate in all plans.

A Patient's Guide to Registration, Billing, and Collections

The physicians and staff of Kosciusko Medical Group (KMG) wish to serve the medical needs of the community effectively and as compassionately as possible within the constraints of sound fiscal management. If you have questions regarding insurance filing or your statement, please call the business office at (574) 372-7617 (574) 372-7617 .

The Health Insurance Portability and Accountability Act is a federal law that protects and secures the privacy of the patient's individual medical information.

Payment at Time of Service
The patient's copay is required to be paid at the time of check–in. Our offices accept payment by cash, check, credit card, or debit card. In the case of unaccompanied minors, the parents (or guardians) are responsible for providing insurance information and payment at the time of service.

Insurance Filing
Insurance is a contract between the patient and his/her insurance company. Although KMG will bill the insurance company, the patient is ultimately responsible for payment of the account. If we are in network with a patient's insurance company, we will handle the claim according to the contract. Patients will receive a statement after we have received payment or a response from the insurance company.

To make sure that insurance is filed promptly and with assignment of benefits to our offices, we will file insurance as outlined above with appropriate authorization from the patient.

Denial of Claims
KMG will not become involved in disputes between the patient and his/her insurance company regarding deductibles, co–payments, non–covered charges, secondary insurances, usual and customary charges, etc. other than to supply factual information as necessary. The patient is responsible for the timely payment of his/her account.

In the event of services rendered as a result of an auto accident, KMG will file the claim to the patient's personal auto insurance. If auto insurance information is not obtained at the time of service, the charges will be filed to the patient's medical insurance. If the claim is denied, the charges become the patient's responsibility. We will not become involved in disputes between the patient and his/her auto insurance company regarding services rendered as a result of injury from an auto accident or accidents not related to automobiles.

Worker's Compensation
Worker's Compensation claims require the patient to bring in written authorization from the employer. Failure to provide employer authorization will result in full payment at the time of service.

Medicare and Medicaid Non–Covered Services
Medicare and Medicaid only pay for tests and procedures considered to be medically necessary. Prior to services being rendered, the physician staff is required to identify Medicare and Medicaid non–covered services and issue an Advanced Beneficiary Notice of Non–Coverage form (Medicare) and/or Waiver of Liability form (Medicaid) to notify the patient of the financial responsibility.

  1. The patient may sign the form, have the test or procedure performed, and be billed for the test or procedure.
  2. The patient may refuse to sign the form, have the test or procedure performed, and be billed for the test or procedure. The patient refusal will be signed by a witness to indicate that the form was given, but refused, and permission for tests or procedures was given.

Medicare and Medicaid patients will not receive a statement until after payment or other response has been received from Medicare and/or Medicaid.

Secondary Insurance
KMG will file secondary insurance claims as a courtesy to the patient if the insurance information was given at the time of service. If the balance is not paid within 30 days from the date of secondary insurance filing, we will bill the patient the balance, unless otherwise restricted.

Initial Request for Payment
After insurance processes a patient's claim, KMG will send a statement showing total charges and total payments received on the claim. This statement is the first notification a balance is due, and full payment is due upon receipt.

Credit Arrangements
Every reasonable attempt will be made to communicate with patients regarding their accounts and work with them to reach agreeable resolutions within federal guidelines and company policies. Communication methods will include computer generated statements and telephone contacts.
If full payment of the outstanding balances presents a severe financial hardship, please call the business office at (574) 372-7617 (574) 372-7617 .

All accounts must be resolved no later than 60 days from the date of service. Resolution of the accounts includes the following:

  1. The account is paid in full.
  2. The patient has made acceptable payment arrangements.

Kosciusko Medical Group reserves the right to pursue other legal means of collection. The patient or guardian will be responsible for all charges to collect the past due balance, ie. collection fee, attorney fees, etc.

Medical Records Copying
As permitted by Indiana law, a fee may be assessed for the copying of your medical records. The fee for this service must be paid in full prior to the release of any medical records. Records will not be released without a signed statement by the patient or the patient's legal guardian.

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*A physician owned hospital.

If you are experiencing a medical emergency, call 911.
Patient results may vary. Consult your physician about the benefits and risks of any surgical procedure or treatment.