Payment Policy

Women's Health Services Payment Policy

At Women's Health Services we will work with you to bill your insurance, find funding, or charge you at a reduced rate if you are unable to pay for some services. Please bring your insurance or Medicaid card with you to all appointments. Please pay required co-pays or non-covered charges at the time of service.

• Insurance. We participate in most insurance plans, including Medicare. If you are not insured by a plan we do business with, a payment is expected at each visit.
• Co-payments and deductibles. We are required to collect co-payments or deductibles at the time of service.
• Non-covered services. Please be aware that some - and perhaps all - of the services you receive may be non-covered or not considered reasonable or necessary by Medicare or other insurers. You must pay for these services in full.
• Nonpayment. If you do not pay on your account in 90 days, we reserve the right to send your account to a collection agency.
• If you are receiving Family Planning Services, you may be eligible for a partial or even a full discount for these services. This would cover only routine exams and the birth control method of your choice. Please make sure you know which services are covered.
• If you are over 40, you may qualify for the Breast and Cervical Cancer Screening Program. This may cover some of your care. Ask about this program if you wish to be considered for eligibility.

Questions?
Ask for our billing department at 563-243-1413.

Different health care plans provide coverage based on a variety of issues. While income can play a factor with some plans, coverage can also be determined by age, the type of test or procedure, and need.

Mammogram Coverage
Routine screening mammography is done when there are no signs, symptoms, or history of disease. It is usually ordered as part of a routine physical exam.

Medicare pays for routine mammograms annually for women over 40. For women aged 35-40, ONE baseline mammogram is covered by Medicare during this time period. The Medicare deductible does not apply to a screening mammogram, but the 20 percent coinsurance does. A doctor's referral or prescription is not necessary for a screening mammogram to be done, but most facilities do require an order from a physician to do the screening. To be paid by Medicare, 365 days/1 year must pass before a woman is eligible for another screening mammogram.

Pap Smear Coverage
A Pap smear provides for early detection of cervical cancer and occasionally detects other conditions of the cervix and vagina. A routine screening Pap smear and pelvic exam is done when there are no signs, symptoms, or history of disease. The American Medical Association recommends a yearly Pap for all women over age 18 or once they become sexually active, whichever comes first.

Medicare pays for routine Pap smears and pelvic and breast exams every TWO years for a woman who is considered low-risk for developing cervical or vaginal cancer. The Medicare deductible does not apply to a screening Pap, but the 20 percent coinsurance does. If a woman is considered low-risk, she will be financially responsible for the year that Medicare does not pay. The cost is minimal compared to the high price of not detecting cancer in the early stages. At least 23 months must have passed since the previous Pap in order for Medicare to pay.

If a woman is considered high-risk, Medicare pays for a screening Pap every year. For high-risk patients, at least 11 months must have passed since the previous Pap in order for Medicare to pay. The following are conditions that would place a woman at high-risk for developing cervical or vaginal cancer:

• is of childbearing age and cervical or vaginal cancer is present;
• has had an abnormal Pap within the last 3 years;
• onset of sexual activity was under 16 years of age;
• had five or more sexual partners in a lifetime;
• has a history of sexually transmitted disease;
• has an absence of three negative Pap smears;
• has a history of HIV;
• has an absence of any Pap smear within the last seven years;
• had prenatal exposure to DES.

If a woman gets yearly Pap smears and is considered low-risk for developing cervical or vaginal cancer, she will be asked to sign an Advanced Beneficiary Notice (ABN).

For a copy of this paperwork, please follow the link [ABN Form].

This Medicare requirement is a notice that informs the patient that the service being provided may not be covered by Medicare. The ABN outlines the service being provided, the reason Medicare might not cover the service, and the approximate cost to the patient.

The patient must then sign "yes" if she accepts to have the service and, in doing so, agrees to pay the physician if Medicare does not pay, or "no" she does not wish to have the service. The patient receives a copy of the ABN while another copy is kept by the physician and is logged in her medical chart. Medicare is informed of the patient's agreement and if Medicare does not pay, an explanation is sent to both the patient and physician and the patient is responsible for payment.

American Cancer Society Recommendation

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