You are required to present your insurance card at every visit. We must have a copy of your insurance card to file any insurance for you or for your family.
All insurance changes must be given to us at the time of service. If your insurance coverage changes and we are not notified, you will be responsible for all charges. We will be unable to bill your insurance for any prior charges before the change notification.
Your insurance company requires our office to collect copayments (co-pays), deductibles, and coinsurance amounts at the time of service. If you are unable to make your payment according to the terms of your insurance policy at the time of check in, you will not be seen by the Physician.
We have agreed to bill those insurance carriers for all services rendered. This, however, does not always guarantee payment. Therefore, if the insurance company does not pay, payment for services becomes the responsibility of the patient. We require that you assign all insurance company payments directly to our office in order for us to file your claims for you. If an insurance problem occurs, you may be asked to assist us in contacting your insurance carrier to resolve any outstanding claims issues. We can provide you with a receipt acceptable to submit to your insurance company.
We do not file claims to Automobile or Liability insurance plans. If the reason for your visit is a result of an automobile accident or other accident that may be litigated, you will be responsible for payment for services at the time of your visit. We do not handle Worker's Compensation claims; therefore we do not treat any injuries or illnesses that are job-related.
Insurance We Accept
The office of Dr. James J Macool accepts all major insurances (PPOs, HMOs, etc.), and is currently participating in the following insurance plans:
AARP (Only as secondary insurance when Medicare is
BCBS (Panel is closed for Blue Select Obamacare/Marketplace Insurance)
CIGNA (Not in network with Disney, Cigna Local Plus and OCPS)
GHI (Only as secondary insurance when Medicare is
HEALTH FIRST (Florida Hospital Employees)
HUMANA MILITARY TRICARE – (All lines of Humana Military Tricare)
BEECHSTREET (This plan has several Third Party Insurances)
MEDICARE PART B
PHCS (This plan has several Third Party Insurances)
TRICARE STANDARD Only as secondary insurance when Medicare is Primary
UNITED HEALTH CARE
MEDICARE ADVANTAGE PLANS
MEDICAID HMO PLANS
MAGELLAN (only established patients!)
STAYWELL (only established patients!)
MEDICAID (straight) (only established patients!)
PLANS WE DO NOT TAKE
AARP (As primary we are not in network – ONLY SECONDARY)
BCBS (BLUESELECT OBAMACARE/Marketplace PANEL CLOSED)
HUMANA (OBAMACARE/Marketplace PANEL CLOSED)
HUMANA GOLD (We are not in network)
HUMANA HMO (We are not in network)
SUNSHINE (termed in 2016)
We NO LONGER accept any Medicaid, Medicaid products (ie Sunshine State Medicaid, Magellan, etc.), or "Obama Care" plans (Humana Medicaid, BCBS Medicaid), EXCEPT for Stay Well.
If this office is not in your provider's insurance network, you will be responsible for the bill portion not paid for by your medical insurance.
Health Insurance Coverage
Our office makes concerted efforts to provide care within the scope of services covered by your insurance policy and that your test are performed in the properly designated facility.
If you are concerned that your insurance company may not cover services you will receive, please consult your insurance company prior to the date of your office appointment. In the event your insurance plan determines a service to not be covered, you may be responsible for this charge.
Should you have any questions about Insurance, please contact us at 407-774-7781