Information for Clients about Potomac Pathways’ Billing Policies

Potomac Pathways is taking significant steps to reduce the costs of treatment, including negotiating “in‐network” status with insurance companies, and working compassionately with those patients who are uninsured. For many patients with insurance, however, individual insurance plans, including government insurance programs, may hold the patients responsible for a portion of Potomac Pathways’ charges. A summary of Potomac Pathways’ current billing policies is set forth below:

Insured Patients are Billed Deductibles, Co‐Insurance and Co‐Payments as Required by their Insurance Provider

Most insurance providers, with some exceptions, require Potomac Pathways to bill patients for any applicable deductible, co‐insurance and co‐payment amounts, as reflected on the explanation of benefits (“EOBs”) or similar statements furnished by the insurer. These amounts are determined by your insurer, not by Potomac Pathways.

When Potomac Pathways is not contracted with an insurance plan, we will typically bill patients for the amount designated by their plan as the “patient’s responsibility,” including any balance remaining on the bill if the insurer pays less than the “usual and customary,” “reasonable,” or “allowable” charge (collectively, the “Allowable Charge”) for the services provided.

The Allowable Charge is determined by your insurer and indicated on the explanation of benefits (EOB). Generally your insurer will mail you the EOB. Often you can view this information on your insurer’s website, as well. If the full Allowable Charge is paid to Potomac Pathways by the insurer, patients will not be billed by Potomac Pathways.

Insurance Payments Made Directly to Patients

Some insurers may send the insurance payment for Potomac Pathways’ services directly to the client. Clients that receive a check for services provided by Potomac Pathways are responsible for forwarding this payment to Potomac Pathways. Please write on the back of the check “Pay to Potomac Pathways,” include a signature and mail to Potomac Pathways at the address below:

7945 MacArthur Blvd
Suite 214
Cabin John, MD 20818

If clients do not forward the payments to Potomac Pathways, Potomac Pathways may send these patients to an outside collection agency. For those insurance companies that engage in this policy and white whom Potomac Pathways is not contracted, Potomac Pathways is generally required to hold the patients responsible for any balances above the amount they received and remitted back to Potomac Pathways as payment for our services.

Patient Billing, Payment Support Options and Financial Support Program

Potomac Pathways understands that providing quality client care has a related cost, which in some situations may be burdensome for clients and result in some patients avoiding certain necessary services because they are concerned about the expense. Potomac Pathways is committed to delivering the best client care to all, and to meet this objective has established programs to ensure affordable access to Potomac Pathways’ services.

The Company will send a Statement of Account to clients who are responsible for deductibles, coinsurance, co‐payments or other balance as set forth above. The following payment options, which are subject to change, may apply:

No Insurance. If you are not insured, Potomac Pathways may offer an uninsured rate. Please contact Billing Services for rates based on the services.

Payment Plan. Potomac Pathways may enter into a payment plan for outstanding balances; eligibility shall be individually determined.

 

All clients are encouraged to call Potomac Pathways’ Billing Services (301-987-7284) if they have questions or concerns about their bill. Potomac Pathways Billing Services is available Monday through Friday, from 10:00AM – 5:00pm.

All information subject to change without notice.