Frequently Asked Questions
I have insurance but still owe money, why?
Insurance companies do not always pay for all medical services, even those that might be helpful to the patient. It is very important for you to know and understand your insurance benefits. There are many policies and plans for each person or employer group, and we are unable to determine what your policy benefits are for each visit based on the information on your insurance card.
What types of insurance do you accept?
We accept most major insurance and most of the small companies as well. We accept all Intermountain Healthcare plans, including Select Value. If you are unsure about your insurance, please call your insurance company to verify that you can be seen at Mountain Peaks Family Practice.
Processing Claims: If you are insured, Mountain Peaks will try in every way we can to make the processing of insurance claims as simple as possible. In order to do this, we ask that you please come to your child’s appointment with your current insurance card to ensure we have the most correct information for claim submission. We also ask that you are prepared to pay any patient portion that you may owe or that is required of you to pay.
Cash Pay: If your children are not insured, payment is expected at the time of service. We offer a discount to cash pay patients.
Here are just a few of the health plans and insurance companies we accept. Please feel free to contact us if you do not find one you are looking for:
- Blue Cross
- Group Benefits
- Intermountain Healthcare
- Intermountain Ironworker
- Health & Welfare Trust Fund
- Meritain Health
- SelectHealth (including Select Value)
- Tall Tree
- United Health Care
- Utah Sheet Metal Welfare Trust
*please call to verify which HMO
How does my insurance plan work?
Insurance plans change frequently and sometimes you may not be aware of these changes until you get a bill. Don’t let this happen to you. Review your handbook sent to you by your insurance company so you are familiar with your plan. Review what is covered or what may be applied to your deductible. Call your employer or human resource department and ask them questions or set up an appointment to learn more about your plan.
We encourage you to ask your insurance plan important questions regarding your benefits such as:
- Do I have well child or preventative care for my child?
- Is there a limit or maximum benefit to the well child or preventative care?
- Are the vaccines covered by my insurance?
- Are there vaccine coverage limitations? Mountain Peaks follows the current immunization guidelines established by the American Academy of Pediatrics (AAP) and the Center for Disease Control’s Advisory committee on Immunization Practices (ACIP).
- If my child is having an office procedure done, such as wart removal, mole removal, fracture care, laceration repair etc.; what will I be responsible to pay?
- Does my plan have a deductible that will need to be paid each year and how much is my deductible?
- How much is my copayment?
- Coinsurance is a percentage of the charges that may be your responsibility and is not part of the copayment.
- Is the physician or physician assistant participating with your insurance plan?
What about my high deductible insurance plan?
Due to the increase of high deductible insurance plans, we will collect a $50.00 payment toward your visit at the time of service. After your insurance processes your claim we will send you a statement for any balance due.
Do your work with custody and foster care patients?
We work with patients in most circumstances. Here’s what you’ll need:
- Both biological parents are responsible for paying any balances due at Mountain Peaks Clinic.
- We will bill the parent who has brought the child in and/or signed the patient contract.
- This may be changed upon written consent from a parent.
- Both biological parents may have access to the child’s medical records unless we have a court order indicating otherwise.
- Custody simply tells us which parent has physical custody of the child and does not stipulate who has access to the medical records.
- If you are bringing in a foster child, you must bring in their from TR01 (Shelter/Foster placement verification and medical authorization letter). We will no longer allow foster children to be seen without this form. The children must be accompanied by on of the Foster Parents or their case worker. We cannot see foster children when brought in by a tracker or another unauthorized person. We will scan the form TR01 and attach it to the patient’s medical record.
What does "coding an office visit" mean?
Federal laws require Mountain Peaks Clinic to submit every claim to an insurance company accurately, reporting the exact services performed and the exact reason for performing them. Sometimes insurance companies may not pay all charges as they were submitted by Mountain Peaks Clinic. We cannot change a diagnosis code or a procedure code after the original claim submission just so insurance will pay the claim or specific services.
We may change the code if it was initially submitted incorrectly. Sometimes during a preventive health visit, the physician will diagnose and treat another problem. Services for the other problem will be billed as an additional charge. Some insurance companies will not cover two office services on the same date so payment for one of the services may be denied by the insurance company or an additional co-payment may be required.
After we receive a response from your insurance, you will receive a statement indicating any amount that you may owe. Payment is expected at the time of service. We realize, due to an benefit coverage, you may not know the exact amount to pay. We ask that you pay immediately upon receipt of your first statement any and all balances which are due.
What if I have other questions?
Don’t be afraid to ask questions…
As always, we will send you to contracted facilities and providers so that your bills will be processed in network, however, please know that this does not mean your services will be covered 100%. You still may receive bills especially if you have a deductible plan.
So Again… Ask questions
We encourage you to contact your insurance company to find out what your deductible or share of cost may be before you have any tests or lab work done. Before you have any services done outside of the clinic find out what your portion will be.
Walk in Appointments Available Daily
We are committed to serve you as quickly as we can. Some days get very busy, so it’s usually best to call ahead.