Health Insurance Benefits

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The following information is provided to assist you with insurance benefit issues. There are many different insurance companies that offer health care benefits. Our office participates with Medicare, Blue Cross Blue Shield of Michigan, Medicaid, NGS, Tricare, Priority Health, Sault Tribe and MDPH (Breast & Cervical Cancer Screening Program & Colorectal Cancer Screening Program). While we do not have contracts with all insurance carriers, we will work with your carrier to help you obtain the maximum benefit allowed under your contract. For this information, please click below on the insurance carrier of your choice.

Medicare

We are participating providers with Medicare. If you have Medicare coverage, all claims are submitted for you by our office electronically. You are responsible for any deductibles and co-payments at the time of service. If you carry a secondary insurance which pays all or a portion of your twenty percent (20%) co-payment, present your insurance card for that insurance at your office visit and our office will bill that secondary insurance for you. Any remaining balance will be your responsibility. If you do not carry secondary insurance coverage you are responsible to pay the 20% Medicare co-payment at the time of service. Occasionally, there will be a service or test that may not be covered by Medicare. You will be asked to sign an Advanced Beneficiary Notice/Waiver Statement and accept responsibility for payment of charges for these services or tests.

Blue Cross Blue Shield of Michigan

We are a participating provider with Blue Cross Blue Shield of Michigan. BCBSM has many different groups with differing benefit packages. These contract benefits (or limitations) are chosen by you or your employer. BCBSM does not pay your bill in full. You are responsible for any deductibles and co-payments at the time of service.

Some Blue Shield contracts cover office visits and consultations, but many do not. We will assist you in determining which contract benefits you have. The contracts that cover office services are called CMM (Comprehensive Major Medical), PSG Contracts with a Major Medical Rider, and Community Blue. With CMM contracts, BCBSM pays your physician directly. PSG contracts with a Master Medical rider provide reimbursement checks to you directly; therefore, you are expected to pay for your visit at the time services are rendered. BCBSM will provide you with an explanation of benefits and outline your responsibility for payment.

Claims are submitted electronically for you by our office. If necessary, we will ask you to speak with your employer or insurance agent regarding difficulties related to billing claims.

Medicaid / Spend Down

If you have Medicaid with a spend down provision, you have an out-of-pocket amount that you must pay monthly before Medicaid begins paying its benefits. Please be prepared to pay any remaining spend down amounts at the time of your appointment.

Please present your most current Medicaid card whenever you come to our office for an appointment. If your spend-down balance has been paid, you should have a Medicaid card. This information can be verified by the office for you. If you have met your spend down amount and you have not received your card, please bring in verification from your case worker that the card is being issued and the spend down has been paid.

Community Choice Michigan (CCM)

We are a participating provider with Community Choice Michigan (CCM). We will submit all health insurance claims for you.

If you are in a CCM plan, we may need authorization from your primary care physician before we can provide the requested services for you.

Commercial Insurance

There are many different commercial health insurance policies and benefit packages available for you and your employer. You should learn about your contract and its benefits. We will not always be aware of your particular insurance benefits, but we are able to assist you in obtaining this information. You are responsible for payment at the time of service. We can assist you in receiving maximum reimbursement from your insurance company by mail or electronic claims processing. Any contract name or telephone numbers that you can provide will assure timely disposition of your claim. We do not have signed agreements/contracts with all carriers. While we pledge to work with you and your commercial health insurance carrier for prompt, full payment of your claim, the ultimate responsibility for paying your medical bills rests with you.

Sault Tribe of Chippewa Indians

If you have health care benefits through the Sault Ste. Marie Tribe of Chippewa Indians, claims are billed directly from our office to the Sault Ste. Marie Tribe of Chippewa Indians.

You must present a valid voucher to our Receptionist upon your arrival authorizing an office appointment or service. If your appointment is rescheduled, please contact your insurance coordinator to obtain another voucher with the newly authorized rescheduled date and time. Presentation of this voucher is a requirement of the Chippewa Tribe Governing Board and defines the scope of services we are authorized to provide.

Northern Group Services (NGS) Sault Tribe of Chippewa Indians

We are a participating provider with NGS. If you are an employee of Sault Ste. Marie Tribe of Chippewa Indians and have health care benefits through the Sault Ste. Marie Tribe of Chippewa Indians, claims are billed directly to Northern Group Services (NGS) from our office. Patients are responsible for co-payments and deductibles on the date of service.

Patients Without Insurance Coverage

Our policy requires payment for office visits and consultations on the day of service. While we cannot determine prior to the visit the exact charges for the visit, we can give you a range of charges. The office can only determine the charges after the visit, as charges are dependant on the extent of services rendered. Charges are determined after the physician's evaluation of your history (personal and family), review of past/recent medical records, laboratory and x-ray studies, physical examination, consultation with other treating physicians, coordination of care, and the complexity of problem solving and medical/surgical management.

Northern Health Plan

Cheboygan Surgical Associates participates with Northern Health Plan.

If you are currently uninsured, you may qualify for the Northern Health Plan. Click on the link below to find out how to qualify for Northern Health Plan benefits.

File Download: Northern_Health_Plan.doc