Credit Card On File Program

Dear Patient:

We have implemented a policy requiring a credit card held on secure file for each patient, effective September 1st 2015.  As you know if you have ever checked into a hotel or rented a car, the first thing you are asked for is a credit card, which is stored and later used to pay your bill.  Physicians extend more credit than any business except banks, who charge interest and fees to do so.  As you may be aware, the current healthcare market has resulted in much higher deductibles, coinsurances, and copays not known at the time of service.

Our new policy will require that your credit card will be swiped, similar to any other credit card transaction, and held on file with KEY BANK, a secure third party.  Your insurance company will process your claim, pay their portion, and notify us of the total patient responsibility.  At that time, balances $5 or less will be charged immediately, otherwise you will receive a statement from us with your remaining balance.  Please contact us within 30 days to arrange for payment.  After 30 days, we will charge your balance to your credit card on file.

This in no way compromises your ability to dispute a charge or question your insurance company's determination of payment.  You are also encouraged to call your insurance company to confirm your benefits before your visit.

Any amounts credited to your account will be refunded to your card immediately.

 

Please read the full details of our Credit Card On File Policy and Frequently Asked Questions, or see the Authorization Form patients sign at our office.

 

Thank you in advance for your cooperation.

 

Michael A Farbowitz, MD

Short Hills Ophthalmology Group

Full Policy

Credit Card on File- Full Policy

Short Hills Ophthalmology Group is committed to reducing waste and inefficiency and making our billing process as simple and easy as possible. We require that you provide a credit card on file with HIPAA-compliant, secure Key Bank online software. When you come in, we will swipe your card with a card reader, much the same as any other credit card transaction.  To place your card on file, we must charge ONE CENT(.01), but will reimburse you in cash at the time of swiping.  Office personnel will not have access to your card. For your protection, only the last 4 digits of your card will show in the system.

Once your insurance company has processed your claims, they will send an Explanation of Benefits (EOB) to both you and our office showing what your total patient responsibility is. You typically receive the EOB before we do, so if you disagree with the patient amount owed, it is your responsibility to contact your insurance carrier immediately.

When we receive the EOB, we will enter this information into our system and subtract the payments and adjustments required by the insurance company.  The remaining balance will be only what the insurance company has determined you owe on the claim.

Once that information is entered into our system, balances $5 or less will be charged immediately, otherwise you will receive a statement from us for the balance that you owe.  If you wish to give a different method of payment than the card on file or if you would like to split your balance into multiple payments, call our billing office at 973.546.6161 and speak to Becky to make arrangements.  You must call to make arrangements within 30 days of the statement date or your credit card will be billed for the total amount owed.

 

It is your responsibility to ensure that the card you have on file is not expired or cancelled and has an appropriate amount of available credit.  Please call our office immediately if you need to update your credit card on file.  If your payment is declined, a $35 declined payment fee will be applied and a warning letter sent. If we receive no response within 30 days of the letter date, your account will be sent to a collection agency.  Please note: we understand that you may not remember to update your card on file.  We will remove the declined payment fee when you respond to the letter.

 

Credit Card on File Policy-  No Credit Card


We understand that you may not have a credit card or available credit.  In that case, you may place $100 on your account (in addition to your co-pay) which will be held until your claim processes.  We will refund any funds due back to you immediately after covering the patient responsibility amount defined by your insurance company. Please remember that you will need to put $100 on your account for each visit. Thank you in advance for your cooperation. Short Hills Ophthalmology Group

Frequently Asked Questions

 

Q:        “I’ve never heard of a doctor’s office having patient credit cards on file.  Why are you doing this?

A:         Although this is new to you, you will see it happen at more and more of your doctor’s offices.  Insurance reimbursements are declining, patient responsibility amounts are increasing, and the expectation is that we become more efficient in our billing practices.  To be able to continue providing the services and care that you deserve, we have to work smarter.  You can’t stay at a hotel or rent a car without a credit card on file.  Just like those merchants, we too need to be paid for our services.

Q:        “I don’t have a credit card.

A:         You are welcome to leave a debit card on file or leave a $100 deposit at each visit.  Once your insurance company processes your claim, we will refund the paid and adjusted portions immediately and only keep the amount that the insurance company designated as your responsibility.  We understand that there are legitimate reasons that you might not have a credit card (bankruptcy, maxed out limits, declared unworthy of credit).  If this is the case, it is not fair for us to extend you credit.

Q:        “Why do I have to leave a credit card?  I don’t have a deductible or copay and always pay my bills.”

A:         This policy is not personal at all.  We don’t want to be in the position to judge which patients will have insurance balances and which will not.  Instead of discriminating, we apply this policy to our entire patient population.  In fact, this policy will save you the time and energy of manually paying your bill!

Q:        “What about identity theft, privacy, and security?”

A:         We DO NOT store your credit card information on our files, computers, or servers.  When your credit card is swiped, much like any other transaction, your information is secured on file on the KEY BANK servers.  Your credit card information is not even displayed in full; only the last 4 digits of your credit card number and expiration date is visible in the system.  When you hand your credit card over to your server at a restaurant, you have no idea what your server did with your card, but no one thinks twice about doing so.

Q:        “Isn’t it illegal to balance bill me after the insurance company pays on my claim?”

A:         Balance billing is asking the patient to pay the amount that the insurance company tells the doctor’s office to write-off.  That is a breach of our managed care contracts and we have NEVER engaged in this illegal practice!  The amount we will be charging to your credit card is ONLY the amount your insurance company designates is your responsibility to pay, after we have subtracted the payment and write-off amounts from the total.

Q:        “My insurance co. wants to know if this policy is legal, and so do I.  Is it?”

A:         Yes.  Having a credit card on file system IS LEGAL, just as it is for hotels and car rental companies.  It is natural for your insurance company to be concerned about you, but we have every right to collect the patient-owed balances that they themselves designate.  In fact, what IS illegal is writing-off balances that the insurance company tells us is your responsibility!

Q:        “What if I refuse to participate in your credit card on file program?”

A:         Our credit card on file policy is mandatory for all Short Hills Ophthalmology patients.  We can no longer afford to practice as we have in the past, and our sincere hope is that our patients understand and accept this.  Patients who cannot accept the policies and procedures of any of their doctor’s offices should find more like-minded practices.  We feel that the need to institute this policy is as uncomfortable for us as it is for you, but it is necessary.

Q:        “Can you tell me what my bill will be ahead of time?”

A:         There is no way for us to know what you will owe for your visit.  Every patient can have different benefits, regardless of the name of the insurance company.  The most important thing you can do as the patient is to call your insurance co. and ask them what YOUR benefits are.  They will tell you what your deductible is, how much you’ve met of your deductible, your co-pays, and your coinsurance.  They can also tell you if you have a regular vision exam benefit or if you only have medical exam coverage.  Knowing your benefits is the surest way to know if you will have a balance after your visit.

Q:        “What if there is a problem with my bill and I don’t notice it until after you charge my credit card?”

A:         We routinely review the accuracy of claims processed by insurance and will contact you if we find a problem.  If you disagree with the way your insurance company designated the amount you owe, you need to contact your insurance company and ask them why they processed the claim that way.  We will be happy to help you with any information or documentation you need to appeal with your insurance company.  Most insurance representatives will even call our office with you on conference call if you ask them to, so that any and all issues can be resolved for you with both our office and your insurance company simultaneously.  If your claim is reprocessed, we will refund any balance due to you immediately

 

Credit Card on File Authorization Form


At Short Hills Ophthalmology, we require keeping your credit card on file as a convenient method of payment for the portion of services that your insurance company doesn’t cover, but for which you are liable.   (PLEASE SEE CREDIT CARD ON FILE POLICY FOR FULL DETAILS.)               Initial___________________

Your credit card information is kept confidential and electronically secure at KEY BANK.  Charges to your credit card are made only after the claim has been filed and processed by your insurer and the insurance portions of the claim has been paid, adjusted, and posted to your account.

I, the undersigned, authorize Short Hills Ophthalmology Group to charge the portion of my bill that is my financial responsibility as per the insurance company EOB to the following credit card.  Balances $5 or less will be charged immediately, otherwise I will receive a statement from Short Hills Ophthalmology for the balance my ins company determines I owe.  I understand that my credit card will be charged 30 days after statement date if other arrangements have not been made.  I will receive a receipt via email only.  A one-time charge of one cent (.01) will be charged, and I will be reimbursed in cash at time of swipe.  I agree to notify and update my credit card as necessary.  A $35 fee will be added to my account if my credit card declines.  This authorization will remain in effect until I cancel it.  To cancel, I must give a 60-day notification to Short Hills Ophthalmology in writing and the account must be in good standing.

___AMEX               ___VISA              ___MasterCard                         ___Discover

LAST 4 DIGITS Credit Card# _______________       Expiration________/________

PATIENT Name            ___________________________________________________

Cardholder Name            _________________________________________________

Signature                    ____________________________________________________

Billing Address            ___________________________________________________

Email Address             ___________________________________________________

Signature                    ______________________________________   Date_________

Credit Card on File Authorization Form

At Short Hills Ophthalmology, we require keeping your credit card on file as a convenient method of payment for the portion of services that your insurance company doesn’t cover, but for which you are liable.

(PLEASE SEE CREDIT CARD ON FILE POLICY FOR FULL DETAILS.)                    initial___________________

Your credit card information is kept confidential and electronically secure at KEY BANK.  Charges to your credit card are made only after the claim has been filed and processed by your insurer and the insurance portions of the claim has been paid, adjusted, and posted to your account.

I, the undersigned, authorize Short Hills Ophthalmology to charge the portion of my bill that is my financial responsibility as per the insurance company EOB to the following credit card.  I, the undersigned, authorize balances of up to $100 to be charged on the Friday of the week after I receive the EOB, and I will be sent a receipt.  I will receive a statement from Short Hills Ophthalmology for balances over $100, but my credit card will be charged for any balance 30 days after the statement date if no other arrangements have been made.  A one-time charge of one cent(.01) will be charged, and I will be reimbursed in cash at time of swipe.

___AMEX               ___VISA              ___MasterCard                         ___Discover

LAST 4 DIGITS Credit Card# __________________             Expiration__________/__________

PATIENT Name           ____________________________________________________________

Cardholder Name      ____________________________________________________________

Signature                    ____________________________________________________________

Billing Address           ____________________________________________________________

Email Address            ____________________________________________________________

I, the undersigned, agree to notify Short Hills Ophthalmology and update my credit card on file in the case of expiration, cancellation, or lack of credit on credit card listed above.  A $35 fee will be added to my account if my credit card declines.  This authorization will remain in effect until I cancel it.  To cancel, I must give a 60 day notification to Short Hills Ophthalmology in writing and the account must be in good standing.

Signature                    ________________________________________    Date______________

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Patient Testimonials

Staff and services rated 10 out of 10. The results are truly excellent.

- B.C. 25 - Finance

Dr. Farbowitz took the time to answer all of my questions and alleviated any fears I had of the procedure. Its hard for me to remember what life was like with glasses. Its so much better playing sports, swimming, waking up in the morning, watching movies, etc.

- A.W. 41 - Accountant

To me this is all a dream and each day that I wake up I have Dr. Farbowitz and his staff to thank! I would recommend Short Hills Ophthalmology, specifically Dr. Farbowitz, to my family and friends, as well as anyone else who is considering having LASIK. You will not be disappointed!

- J.P. 24 - Teacher

As a result of Dr. Farbowitz performing LASIK surgery has given me a sense of liberation from glasses and contacts that feels indescribable.

- J.T. 29 - TV Station Operations Manager

Having LASIK performed by Dr. Farbowitz was truly amazing. The doctor and his staff made me feel comfortable before, during and after the procedure.

- D.S. 31 - Pharmaceutical Manager

Everyone was very professional, accommodating, excellent approach to flawless surgery, accessible and very congenial.

- L.M. 38 - Public Relations Consultant

Dr. Farbowitz and his staff are very professional, very timely and very confidence inspiring!

- A.J. 42 - Derivative Marketer

What I liked best was that I received a thorough explanation of what to expect, a comprehensive exam and friendly professional eye care.

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