Billing Department

Hours
Mon-Fri: 8:30am – 4:30pm
Phone:
(845) 342-5199
Fax:
(845) 343-3295
(845) 343-8741

Address

2142 Route 302
Circleville, NY 10919

Overview

Continuous changes with health insurance plans makes it extremely important to understand your coverage, including the costs you must pay when visiting your physician or when having tests and procedures. For this reason, Middletown Medical recommends that you learn the specifics of your plan before your next appointment. For example, your health insurance plan may require multiple copays, higher deductibles, and coinsurance. Coverage will depend on the type of plan you have chosen.

We accept most major insurance plans. Call our offices for the most current information if you don’t see your insurance plan listed below. Participating providers subject to change without notice.

Effective April 5, 2016, we will no longer accept Crystal Run Health Plan for services but we will still accept Magnacare

Effective January 1, 2024, we are Non-Par with United Medicare HMO or POS plans.

Patients who are part of retiree groups, with the word RETIREE printed on the back of their cards, we remain in the network with.

Pateints that are covered under a PPO plan can continue to come to MMPC on an out of network basis.

Effective April 15, 2024, we Non-Par with Cigna.

CIGNA patients covered under PPO or Open Access plans can continue to come to MMPC on an out of network basis.

Insurances We Accept

A-F

AARP MedicareComplete (Only if the card says RETIREE)

American Progressive

Aetna (PPO)

Aetna (HMO)

Aetna Medicare

Anthem

Beech Street

BCBS EPO

BCBS HMO

BCBS Mediblue Par 6/1/2024

BCBS Medicaid- prefix JLJ We will accept this insurance effective 6/1/24

BCBS - prefix VFG, VJD We will accept this insurance effective 6/1/24

BS of Northeastern Healthnow

CDPHP

Connecticare

EmblemHealth HIP Medicare (We Only accept NYC Retirees Empire BC/BS PPO/EPO)

Fidelis Essential Plan - Requires PCP assignment Fidelis Medicare

Fidelis Medicaid

Fidelis HMO

First Health (By Aetna)

G-M

GHI

GHI HMO

GHI HMO Medicare Plan

HealthFirst

HealthPlus MA DSNP - Y8E We will accept this insurance effective 6/1/24

HealthPlus MA HMO - Y7N We will accept this insurance effective 6/1/24

HIP HMO

Local 338 Health Plan

Local 812/Vista/Crossroad

Local 825

Local 1199 SEIU Benefit Fund

Magnacare (except Crystal Run Health plan products)

NY Medicaid on a case by case basis

Medicare

Medichoice

Mediblue HMO Senior Plan

Molina

Multiplan

MVP

O-Z

Oxford

Oxford PHS/Healthnet

Pomco

Railroad Medicare

Secure Horizon Oxford

Seiba

Tricare HMO - Requires a referral to see specialists and for testing

Tricare – Active Military

United Healthcare Empire

United Healthcare (HMO)

United Healthcare (PPO)

US Family Health Plan – Tricare Prime Program PPO

We now accept payments from CareCredit®. What is CareCredit®?

CareCredit® is a health, wellness, and personal care credit card that helps patients and clients get the care they want and need, without delaying appointments or treatment.

Cardholders can use CareCredit promotional financing to pay over time for deductibles, copays, and treatment not covered by insurance,* while you get paid in two business days.

Visit www.carecredit.com for more information.

Pay CareCredit

More Info

To learn the details of your individual health care policy, you can visit your insurance company’s website, review your member booklet or contact your company’s customer services department. The back of your insurance card should include the phone numbers and website information.

Some key information you need before your visit:

Is my doctor’s visit covered completely? If not, do I have a copay or deductible amount to meet?
If I need any tests, will they be covered completely? If not, how much will I be expected to pay?
If I need a procedure, including surgery, how much will my insurance cover? How much will I be expected to pay?
Will I need authorization before my health care visit?

Billing FAQs

What is a deductible?

A deductible is the initial amount of “covered” health costs that you pay before your insurance plan begins reimbursement. A deductible is usually a set dollar amount, such as $250 or $500, but can be higher based on the policy you have chosen.

If your insurance pays all but a deductible, you will be required to pay an estimate of your portion of the bill at the time of service.

What is co-insurance

Co-insurance is your share of the costs of a healthcare service. It is usually figured as a percentage of the total charge for the services. You start paying co-insurance after you’ve paid your plan’s deductible.

For example, if you’ve paid your $1,500 deductible for the year, and your plan covers 70% of a particular cost, then you’re responsible to pay the other 30% — that’s the co-insurance.

It is in your best interest to understand what your insurance does and does not cover, of example co-pays, deductible and co-insurance, what you are responsible for, and what we require from you at the time services are provided to you at Middletown Medical

What types of insurances does Middletown Medical accept?

We accept many types of health insurance plans, Medicare, Medicare Advantage Plans, HMO, PPO, and Managed Care plans. For a list of all of them CLICK HERE.

What is a co-payment?

A co-pay (co-payment) is the portion of your healthcare expenses not covered by insurance. It is the amount your insurance company states is your responsibility for each service you have rendered, and is required to be paid at the time of treatment.

Your co-pay information may be listed on your insurance card as the following: PCP, Specialist, Urgent Care, ER. There also may be separate co-pays for each type of service.

Examples: Office visit, Lab (blood work), Diagnostic testing (x-ray).

Who is responsible for paying my bill?

You are responsible for your co-pay, co-insurance and/or deductible at the time of service.

Middletown Medical will bill your insurance company directly on your behalf (unless you specify otherwise); however, you are ultimately responsible for making sure that your bill is paid.

If a balance remains after your insurance has issued a payment of a denial, you will receive a bill asking for payment, which is due immediately upon receipt of your statement. We accept cash, checks, money orders and credit cards.

In certain circumstances, you will be able to make monthly payments to Middletown Medical until your bill is paid in full. You should discuss this with our Billing Department by calling 845-342-5199 (open weekdays from 8:30 a.m. to 4 p.m.).

HELPFUL DEFINITIONS:

Beneficiary: A person who receives benefits of any insurance plan or policy.

Claim: A request for payment for services submitted by the provider.

Co-insurance: A specified percentage of covered expenses which the insurance carrier requires the beneficiary to pay toward eligible medical bills.

Co-pay or Co-payment: A specific set dollar amount contracted between the insurance company and the beneficiary to be paid prior to any services rendered.

Covered Services: Services for which an insurance policy will pay.

Deductible: A specified dollar amount of medical expenses which the beneficiary must pay before an insurance policy will pay.

Explanation of Benefits (EOB): A statement from an insurance company showing the processing of a claim.

Medically Necessary: Treatments or services that insurance policies will pay for as defined in the contract.

Non-Covered Services: Services for which an insurance policy will not provide payment. These services are to be paid by the patient at the time of service.

Pre-Certification/Authorization: A service-specific requirement that your insurance company’s approval be obtained before a medical service is provided.

Provider: A person or organization that provides medical services.