Billing Department

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

24 Edgewater Drive

(845) 342-5199

24 Edgewater Drive
Middletown, NY, 10940

DIRECTIONS

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.

Have any questions?

If you have any billing or insurance related questions please email us at billing@middletownmedical.com

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

Insurances We Accept

A-B

● AARP MedicareComplete Plan 2 - need to choose a PCP
● AARP MedicareComplete Plan 1
● AARP MedicareComplete Plan 1 - need to choose a PCP
● AARP MedicareComplete Essential
● AARP MedicareComplete Plan 2
● AARP MedicareComplete Plan 3
● AARP MedicareComplete Complete
● AARP MedicareComplete (Gatekeeper)
● American Progressive
● Aetna (PPO)
● Aetna (HMO)
● Aetna Medicare
● Aetna U.S. Healthcare
● Affinity
● Anthem
● Beech Street
● Blue Cross Blue Shield HMO
● BS of Northeastern Healthnow

C-O

● CDPHP
● Cigna HMO/PPO
● Empire BC/BS PPO/EPO
● Fidelis HMO
● Fidelis Medicare Plan
● GHI
● GHI HMO/HIP
● GHI HMO Medicare Plan
● Local 338 Health Plan
● Local 812/Vista/Crossroad
● Local 825
● Magnacare (except Crystal Run Health plan products)
● Medicaid *select physicians
● Medicare
● Medichoice
● Mediblue HMO Senior Plan
● Multiplan
● MVP
● NYS Government Employees
● Oxford PHS/Healthnet
● Oxford

P-Z

● Pomco
● Railroad Medicare
● Secure Horizon Oxford
● Secure Horizon UHC and Evercare
● Seiba
● Touchstone
● Tricare HMO
● Tricare – Active military
● United Healthcare (HMO)
● United Healthcare (PPO)
● United Healthcare Medicare Complete Choice Plan 1
● United Healthcare Medicare Complete Choice Essential
● United Healathcare Medicare Complete Choice Plan 3
● United Healathcare Medicare Complete Choice Plan 4

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.

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