Accepted Payments

• We accept insurance & self-pay
• We do offer payment plans & financial assistance upon request
• ***Insurance Patients: If you use insurance, your copay &/or outstanding balance will be due at the beginning of your appointment. The remaining balance will then be billed to your insurance & you will receive notice of your outstanding balance not covered through insurance via mail &/or electronically. You may pay this outstanding balance through any of the methods listed below.***
• Accepted Patient Payment Methods
  • Cash
  • Checks
  • Debit/Credit Card
  • Online/Electronic (Via Patient Portal)
• We do offer financial assistance to those in need. You can find more information on how to apply at the bottom of the page under "Financial Hardship Application".

Insurance Info & General Dislaimers

DISCLAIMERS

• ‍Example 1: Guardian Provider sends labs to another facility for processing may be subject to additional charges.
• Example 2: Guardian Provider refers patient to a Provider at another facility. Patient will be subject to charges congruent with the Provider whom they were referred to's organizational billing policies..

Payment Options, Insurance Information, and Privacy Protection at Guardian Health

At Guardian Health, we are committed to providing quality, accessible, and affordable care to our patients. We offer a range of payment options, including cash payments, health savings plans, and a variety of insurance plans.

Guardian Primary Care is in-network with all the major local insurance providers in the Southeast Missouri region. We diligently work to bring our patients more affordable and convenient care. WE DO ACCEPT ALL INSURANCES & can bill out-of-network insurances. However, since we may not have contracts with these insurers, we cannot attest to coverage. Regardless of whether we are in-network or out-of-network we will bill your insurance upon your request. (Disclaimer: It is important to note that if the patient has insurance then their agreement is between them & their insurance company which is a separate organization from your healthcare Provider.) Please view next section titled "Insurance Networking Status" for a list of in-network insurances & those which we are actively working to negotiate contracts.

Legal Compliance: Sunshine Act, FTC, and False Claims Act

Health Sharing Plans

We are happy to work with health sharing plans; however, please note that health sharing plans are not subject to the same regulations as traditional insurance. If your health sharing plan does not cover your bill, you will be responsible for the remaining balance.

Usual, Customary, and Reasonable Charges

In compliance with dual fee laws, we must charge usual, customary, and reasonable (UCR) rates for your geographic area, similar to the rates we charge insurance companies under our contracts. We reference the CMS Physician Fee Schedule, which you can review here, in conjunction with our negotiated insurance contracts to calculate these charges. At Guardian Primary Care we do NOT practice balance billing meaning that the patient will never be charged the diference between what the patient's insurance was billed & what the insurance paid.

For out-of-network insurance patients, please note that we may bill your insurance but cannot guarantee coverage and patients will be responsible for all services which are not covered by their policy. Balance billing, where patients are charged the difference between what we bill and what the insurance pays, is NOT practiced at our clinic.

Transparency and the "No Surprises Act"

We adhere to the No Surprises Act, which allows patients to request a transparent cost estimate for services prior to their visit. Please note that this may extend your visit time, and in some cases, we may need additional time to provide a detailed cost estimate.

For cash payment estimates, we recommend referring to the CMS Physician Fee Schedule. Additionally, under the Budget Reconciliation Act, if you are seen by a nurse practitioner, your charges will be 85% of the standard rate.

Patient Rights and Fair Billing Practices

At Guardian Health, we believe in providing fair, accessible, and affordable care. You have the right to choose your healthcare provider under the Affordable Care Act, and if you are receiving care from a nurse practitioner, you can request to be referred to a physician under the Missouri Nursing Practice Act and the Collaborative Practice Agreement Statute.

Privacy Protection and Compliance

We strongly advocate for the protection of your private health and financial data. Our clinic is strictly HIPAA compliant, ensuring that all patient information is kept confidential and secure.

We also adhere to state price transparency laws, ensuring that patients are fully informed about the cost of their care. Additionally, we comply with local, state, and federal regulations when referring patients for specialized services.

We strictly adhere to the Sunshine Act (42 U.S.C. § 1320a-7h), which requires transparency regarding any financial relationships between healthcare providers and medical manufacturers. This law ensures that providers remain unbiased when making care recommendations.

In compliance with Federal Trade Commission (FTC) regulations, we follow strict debt collection guidelines that protect patients from unfair or deceptive practices. The False Claims Act (31 U.S.C. §§ 3729–3733) also plays a key role in our operations, ensuring that billing and claims submitted to insurance companies are truthful and accurate. This law holds healthcare providers accountable for any false or fraudulent claims submitted for reimbursement, protecting both the government and patients from financial misconduct.

Upholding Christian Values and Staying Current

At Guardian Health, we are committed to upholding Christian values in all of our billing practices. We will continue to stay up-to-date on all relevant healthcare regulations and statutes to ensure our practices are in full compliance with federal and state laws. We believe in providing compassionate, honest, and transparent care to every patient who walks through our doors.

Citations for Reference:

• Sunshine Act: 42 U.S.C. §1320a-7h.
• Dual Fee Laws and UCR Rates: CMS Physician Fee Schedule.
• Anti-Kickback Statute: 42 U.S.C. §1320a-7b(b).
• Stark Law: 42 U.S.C. §1395nn.
• False Claims Act: 31 U.S.C. §§ 3729–3733.
• FTC Regulations: Fair Debt Collection Practices Act (FDCPA).
• Budget Reconciliation Act: 42 U.S.C. §1395l(a)(1).
• Affordable Care Act: 42 U.S.C. §18001.
• Missouri Nursing Practice Act: RSMo 335.016.
• Collaborative Practice Agreement Statute: RSMo 334.104.
• No Surprises Act: H.R.133 - Consolidated Appropriations Act, 2021.
• HITECH Act: 42 U.S. Code Chapter 156 - Health Information Technology

When a healthcare provider is "in-network" with a patient's insurance, it means the provider has a contract with the insurance company to offer services at pre-agreed rates. This usually results in lower costs for the patient, such as lower copays, coinsurance, and deductibles. Being in-network helps patients save money compared to visiting an "out-of-network" provider, who does not have a contract with the insurance and may charge higher fees.

Vetting Process for Providers to Become In-Network:

To become in-network, a provider undergoes a process called credentialing. This involves the insurance company reviewing the provider's qualifications to ensure they meet the company’s standards for delivering care. The vetting process typically includes:

1. Education and Training Verification: Ensuring the provider has completed the necessary medical education, licensing, and certifications.
2. Work History Review: Checking the provider’s experience and professional background.
3. Malpractice and Disciplinary Records Check: Reviewing records to confirm the provider has a good standing and no significant legal or professional issues.
4. Contract Agreement: Once approved, the provider signs a contract agreeing to the insurance company’s rates and rules for reimbursement.

This process ensures that in-network providers meet quality and safety standards, giving patients peace of mind about their care.

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Billing Policy

Guardian Primary Care is committed to working with patients to resolve outstanding balances through clear communication and reasonable payment options. If a balance remains unpaid beyond a specified timeframe despite multiple contact attempts, the account may be referred to an external collections agency unless the patient qualifies for financial hardship assistance.

Procedure

1. Patient Financial Responsibility Communication

• Patients are informed of their financial responsibility at the time of service through:
  
  • Verbal communication
  • Written policies, including financial consent forms
  • Insurance verification and estimated cost breakdowns
• Payment is expected at the time of service for copays, deductibles, and self-pay balances.

2. Billing & Payment Timeline

1. Initial Statement:
   
   • A statement is sent within 7-14 days of the claim processing or service date.
2. 30 Days Past Due (First Reminder):
   
   • A second statement is mailed, and a courtesy phone call/text/email is made to remind the patient of the balance.
3. 60 Days Past Due (Second Reminder):
   
   • A third statement is mailed with a written notification indicating the possibility of collections if unpaid.
   • Another phone call/text/email is made offering payment plan options.
4. 90 Days Past Due (Final Notice):
   
   • A final letter is sent via mail or electronic means, stating that the account will be sent to collections if payment is not received within 15 days.
   • The patient is given one last opportunity to contact the office for payment arrangements or submit a financial hardship application.

3. Financial Hardship Assistance

Guardian Primary Care offers financial hardship assistance to eligible patients who demonstrate an inability to pay their medical bills.

Eligibility Criteria

To qualify for financial hardship assistance, a patient must meet at least one of the following criteria:

• Total household income at or below 200% of the Federal Poverty Level (FPL).
• Documented proof of financial hardship due to extenuating circumstances (e.g., job loss, disability, medical crisis).
• Enrollment in government assistance programs such as Medicaid, SNAP, or WIC.

Application Process

1. Request & Submission:
   
   • Patients must complete a Financial Hardship Application and provide supporting documentation, such as:
     
     • Proof of income (recent tax return, pay stubs, or unemployment benefits).
     • Proof of government assistance (if applicable).
     • Explanation of hardship circumstances.
2. Review & Approval:
   
   • The clinic’s billing department will review the application within 10 business days.
   • A decision will be made based on the submitted documentation.
3. Notification:
   
   • Patients will be notified in writing of approval, partial approval (discounted balance), or denial.
   • If approved, the patient will receive an adjusted balance or payment plan options.

Denial & Appeal Process

• If a financial hardship request is denied, the patient may submit an appeal with additional supporting documentation within 30 days of the denial.
• Appeals will be reviewed by the clinic’s leadership team, and a final decision will be made within 10 business days.

4. Payment Plans & Collections Referral Criteria

• Patients who are approved for financial hardship assistance and adhere to an agreed-upon payment plan will not be sent to collections.
• Patients who default on a payment plan or fail to complete the financial hardship application process within 120 days will be subject to collections referral.

5. Sending Accounts to Collections

1. The clinic staff reviews outstanding accounts before submission to ensure accuracy.
2. A final internal review is conducted to confirm all efforts to collect have been exhausted.
3. A notification letter is sent to the patient informing them that the account has been referred to a collections agency.
4. The patient’s account is transferred to a third-party collections agency, which follows all applicable federal and state laws, including the Fair Debt Collection Practices Act (FDCPA) and HIPAA guidelines.

6. Reinstatement of Services

• Patients who have been sent to collections must pay the outstanding balance or establish a new payment plan before scheduling future non-emergent visits.
• In cases of financial hardship, limited exceptions may be made at the provider’s discretion.

Compliance & Legal Considerations

• Guardian Primary Care will comply with all federal and state laws governing medical debt collection.
• All communication regarding collections will be handled professionally, respecting patient privacy and rights.

For questions regarding this policy, please contact our office at: (573)-200-6390