No Surprises Act/Good Faith Estimate

没有人愿意为自己的医疗费用感到惊讶. 这就是为什么它是 重要的是要了解你携带的健康保险，以确定你的财务状况 responsibility is for your medical care.  We are committed to sharing information 这将有助于你在医疗服务方面做出明智的决定.  A 联邦"无意外法案"的一个组成部分就是你有权获得 Good Faith Estimate 说明如果你没有保险或正在参加选举，你的医疗费用将会是多少 to pay for care without insurance.  A Good Faith Estimate will be emailed to all uninsured 或者自费患者在安排他们的预约时.   作为一个病人， 你有权利.  收到账单后，如果总费用超过400美元 Good Faith Estimate, you can dispute the bill.  For questions or more information about your right to a Good Faith Estimate visit www.cms.gov / nosurprises. 

莫菲特健康中心对医疗保健项目和服务的诚信评估

• Description of the service:  Office 访问 = CPT TBD
• Additional services:  Lab / x-ray / medication / procedure =  CPT TBD
• 诊断代码:  ICD-10代码待定
• 预计费用:  20美元的诊疗费加上任何实验室/x光/药物/程序费用待定
• Facility Location: 西四街2899号. Hattiesburg, MS 39406
• 免责声明信息:  这 Good Faith Estimate is an estimate 和 subject to change. 这个估计是 不是合同，而且可能有附加的项目或服务没有包含在合同中 good faith estimate. 你有权发起解决医患纠纷 如果成本超过诚信评估至少400美元，则申请程序.

No Pass Through Billing (Outside Lab Costs)

Any labs not ran on site in our Moffitt Health Center 实验室将由外部执行实验室(Labcorp或Quest)向患者收费 诊断.)

诊所

我们目前接受并提交任何医疗保险索赔. Such as Aetna, Assurant 健康，蓝十字蓝盾MS和周边州，信诺，HealthFirst, Humana， Tri-Care 和 United Health Care in our clinic. We are not considered Network Providers 对于其中一些承运人，所以一定要检查与你的保险公司之前 seeing one of our providers. 我们目前无法接受医疗保险、医疗补助和CHIPS.

For those with Medicare, for help finding a Medicare provider，联络 Physician Finder Line at Hattiesburg 诊所 at 601.261.3518.

药店

振子结构药房 目前能够接受以下保险:Aetna, Advance PCS, Anthem， 密西西比蓝十字蓝盾，Caremark, Caremark联邦，Catalyst, Catamaran， Express Scripts (Cigna), Humana, Medco, MedImpact, OptumRx, Paid, Prime Therapeutics, Rx Solutions, United Healthcare, 和 UMR.

Please note, this list may change without notice. 

拥有健康保险的患者将获得EOB(福利说明). 这 会发送到健康保险公司获得的邮寄地址吗. 保持 请记住，此类邮件可能包含您认为是私人的信息. 请注意 你可以选择不向你的保险公司申请服务. 这个区块 will include coding for the visit along with the diagnosis. Patients have the right 问 Moffitt Health Center not to file for certain visits. It is the patient’s responsibility to notify the Moffitt Health Center staff not to file.

定义为:

• Patients not covered under any health insurance carrier.
• 有健康保险的病人不参与 Moffitt Health Center.

患者承认他们有责任支付所提供的所有服务的费用。 including pharmacy services, on the day of your visit.

你必须提供 Moffitt Health Center with a copy of your insurance card. Your insurance must be current. 百分百 services will be sent to your insurance carrier; you are only responsible for $20.00 provider fee on the day of the services. 这 amount must be paid on the day you visit, either by cash, check, or credit card. We can also charge the amount to your USM ID.

一旦付款确定，(自付额，免赔额和非保险服务)教师/工作人员 会员将透过邮寄地址或九游会国际地址收到结算单. 学生将 see any remaining charge(s) on their SOAR account.
  
必须在学期结束前付款，以便注册下一个学期 term, receive a transcript, or receive your diploma.

在健康保险公司买健康保险的病人 Moffitt Health Center 不参与的，是否被归类为离网帐户. 我们会开账单 100% of service charges to the insurance company; you are only responsible for $20.00 provider fee on the day of the services.

如果网络外保险公司不承担所有或任何费用 病人的服务，病人将欠余额.

你必须提供 the 振子结构药房 with a copy of your insurance card. If they accept the insurance carrier, then they 将实时处理您的索赔，并为您提供共同支付. Patient acknowledges 他们负责支付所提供的共同支付.

研究生助理患者需要在USM有保险. 如果你 如果参加单独的保险，必须签署豁免书吗. If 如果您不签署豁免书，您将自动成为USM学生 保险计划. Please contact the Graduate Office at 601.266.4369 for more information. 

你必须提供 Moffitt Health Center with a copy of your insurance card. All services that are received at USM are covered in full with the USM Student Plan. You must also provide the 振子结构药房 with a copy 你的卡片. 根据药物的不同，药房可能会收取费用. 问 药剂师或药房技术人员在配药前.

The USM Student 保险计划 starts August 1st. Coverage is through United Healthcare. 如欲了解更多有关申请、保费及承保范围的资料，请浏览 保险 Brochure. 

GA, RA和国际学生可以在网站上找到更多信息 USM人力资源网站. 

注意: Moffitt Health Center does not oversee the health plan. Administration of the policy is h和led by USM HR Department.

Moffitt Health Center 在没有病人手写同意的情况下不会泄露任何个人信息. 我们不能向父母、看护人、朋友或其他任何提出要求的人讨论任何信息 information without the patient’s consent. Consent forms are available at the check-in 柜台 Moffitt Health Center.

Financial information can be discussed without consent.

患者或责任方同意支付非上述费用的任何部分 paid by the patient or responsible party’s insurance company. The patient also acknowledges 他们有责任支付所提供的所有服务，如果不是由 the insurance company.  

员工: 在第二次通知后未支付的余额将从工资中扣除. 

Moffitt Health Center 和 振子结构药房 are able to take the following forms of payment: 

• 现金
• 支票(邮寄支票付款至哈蒂斯堡118 College Drive #5066, MS 39406)
• 维萨和万事达
  • 如以 health savings account (HSA) card, please notify our front office staff at checkout. 诊所 or pharmacy charges needing 用HSA卡支付的费用必须在莫菲特健康中心支付. 

• Bursar (charge to your student account)

需要付款的员工可以使用借记卡或信用卡付款 card 和 we can send a receipt via interdepartmental mail. 

学生 谁选择将他们的费用发送到他们的学生账户可以付款 through the Business Office using the following methods: 

在线

• 登录SOAR. Click on Student Dashboard > Student Account > Make a Payment. (弹出式 blockers will keep the Make a Payment link from loading.)
• Credit/Debit Card 2.75% Convenience Fee charged
• eCheck (no Convenience Fee)

Hattiesburg Campus

• Located at 101 Forrest County Hall (FCH) 
• Check, cash or money order (no credit/debit cards)
• Monday - Friday, 8:00 am - 4:30 pm