Insurance, Billing, and Financial Transparency

Dr. Rizvi Wound Care is in-network with most major commercial carriers and government plans. Coverage rules and network status can change, so please confirm with us and with your carrier before your visit. Plans we currently participate with include:

• UnitedHealthcare
• Blue Cross Blue Shield
• Medicare
• Aetna
• Cigna
• Humana
• Cigna HealthSpring
• AARP
• Superior HealthPlan
• Ambetter
• WellCare Health Plans
• WellMed
• WellPoint

We also see patients with other plans on a case-by-case basis. If your plan is not listed, call us at 972-491-1200 and our front desk will check whether we can accept it.

Insurance coverage is a contract between you and your carrier. To avoid surprises, we recommend that you call your insurance company before your visit and ask:

• Is Dr. Hina Rizvi in-network on my plan?
• Do I need a referral or prior authorization for wound care or for a procedure?
• What is my co-pay, my coinsurance, and my deductible?
• Are wound photographs, debridements, and skin substitutes covered?
• Are telemedicine visits covered, and at what level?

Our front desk verifies benefits before the visit when you provide a card at scheduling. If something looks off, we will call you to discuss before you arrive. Our practice National Provider Identifier (NPI) is available on request and on every claim form we submit.

If you are uninsured, or if you have insurance but choose not to use it for a given visit, you can pay directly. We publish a transparent self-pay schedule:

• Telemedicine visit: a self-pay rate is available with no facility fee. The front desk can quote the current rate before your visit. See our telemedicine page.
• In-office visit: available on request. Rates depend on the services provided (evaluation, debridement, skin substitute application, and so on). The front desk can quote a self-pay rate before your visit.
• Procedures and supplies: we will provide a Good Faith Estimate of expected charges before your visit. See our Good Faith Estimate section below.

We will tell you the self-pay rate in writing if you ask, and we will not balance-bill you above the quoted amount for self-pay services unless we agree on a change in advance.

Federal and Texas law protect you from many surprise medical bills. Under the federal No Surprises Act and Texas Insurance Code §1467.051 (SB 1264):

• You cannot be balance-billed for emergency services beyond your in-network cost-sharing.
• You cannot be balance-billed for non-emergency services from out-of-network providers at certain in-network facilities, unless you have given written consent in advance after receiving a notice and estimate.
• For Texas state-regulated plans, an independent dispute resolution process is available between providers and carriers.

If a service we provide may be considered out-of-network on your plan, we will tell you in advance and offer you the option to pay our published self-pay rate, to receive a Good Faith Estimate, or to be referred to an in-network provider. We do not surprise-bill patients in the categories protected by the No Surprises Act.

For background, see the federal CMS No Surprises consumer site and the Texas Department of Insurance at tdi.texas.gov.

We see workers' compensation patients on a case-by-case basis. If your wound is from a work-related injury, please tell our front desk when you schedule. We need:

• The name of your employer's workers' compensation insurance carrier and your claim number.
• Contact information for the adjuster managing your claim.
• Any preauthorization or referral the carrier or your employer's network requires.

Workers' compensation in Texas is regulated by the Texas Department of Insurance, Division of Workers' Compensation. Information for injured employees is available at tdi.texas.gov/wc/employee.

Medicare. We accept Medicare. If you have Original Medicare, we participate as a Medicare provider and accept assignment, which means we agree to the Medicare-approved amount for covered services. After Medicare pays, your supplemental insurance (Medigap) may pay the remaining cost-sharing. If you have a Medicare Advantage plan, please bring your card and we will verify network status before your visit.

Medicaid. Medicaid status varies by plan and by service. If you have Texas Medicaid or a Medicaid Managed Care plan (for example, Superior, Ambetter, or another listed above), call us so we can confirm participation for your specific plan and service line.

Assignment of benefits. By presenting an insurance card and signing our intake forms, you authorize us to bill your insurance and to receive payment directly from the carrier. The next section explains this in more detail.

Insurance plans typically require a co-pay at each visit and may apply your charges to a deductible. We collect the co-pay (and any known coinsurance) at the time of service. Once your claim is processed, your carrier sends an Explanation of Benefits showing what was paid and what you owe. We will then send you a statement for any remaining balance.

• We accept cash, check, debit, and major credit cards.
• We accept HSA and FSA cards for qualifying services.
• We can set up a payment plan for larger balances; ask the front desk or call billing.

If you cannot pay a balance, please call us before it goes to collections so we can discuss options. We follow Texas debt-collection rules and never release more information than is necessary.

We are a private medical practice and not a 501(c)(3) charitable hospital, so we do not have a formal charity-care policy. We do, however, work with patients on a case-by-case basis, especially when a wound requires repeat visits, skin substitutes, or specialty supplies that strain a household budget. Options we can discuss include:

• Payment plans, with monthly amounts that fit your situation.
• A self-pay rate for services that may be cheaper than your insurance copay.
• Referral to home-health, DME, or community programs that may cover supplies.
• Guidance on Medicaid eligibility, Medicare Savings Programs, and Marketplace coverage.

To start a conversation, call our billing line or ask the front desk for the office manager.

If you have a question about a charge, an Explanation of Benefits, or a statement, contact us first. Most billing issues are resolved with a single call.

• Front desk: 972-491-1200 for routine billing questions and statements.
• Billing email: Info@DrRizviWoundCare.com
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  for written questions, itemized statements, and disputes.
• Mail: Dr. Rizvi Wound Care, attention Billing, 7709 San Jacinto Place, Suite 100, Plano, TX 75024.

You can request an itemized bill at any time. We will provide one within 5 business days at no charge.

If you believe a bill is incorrect, you have several options. Please start with us so we can review the chart, the claim, and the carrier's response.

Dispute with Us

• Call or email billing within 90 days of the statement date.
• Tell us the date of service, the amount you are disputing, and why.
• We will review and respond in writing within 30 days.
• We will pause collections activity on the disputed amount during the review.

External Dispute Options

• Insurance disputes (in-network or balance-billing): the Texas Department of Insurance accepts complaints at tdi.texas.gov or 1-800-252-3439.
• Self-pay Good Faith Estimate disputes: if your final bill exceeds the Good Faith Estimate by $400 or more, you can use the federal Patient-Provider Dispute Resolution process. Information is at cms.gov/nosurprises.
• Texas-protected balance billing: Texas state-regulated plans can use the independent dispute resolution process described at the Texas Department of Insurance.

We will not retaliate against you for disputing a bill.

Our intake forms include an Assignment of Benefits clause. Signing it authorizes us to do two things:

• Bill your insurance company directly for the care we provide.
• Receive payment from the insurance company on your behalf, up to the amount they cover.

If your carrier sends payment to you instead of to us (some plans do this for out-of-network services), you are responsible for forwarding it. If you have questions about this, ask the front desk before you sign. You may also withdraw the assignment for future services at any time, in writing.

Who This Applies To

If you are uninsured, or if you are insured but choose not to use your insurance to pay for care at Dr. Rizvi Wound Care, you have a right to receive a Good Faith Estimate of the expected charges before you receive care. This right comes from the federal No Surprises Act and the regulations at 45 CFR § 149.610.

Your Good Faith Estimate will list:

• The services and items you are likely to receive at the visit.
• The expected charge for each service or item.
• The diagnosis codes and service codes that apply to your care.
• The name, address, and federal taxpayer identification of every provider expected to be involved in your care.

Wound care sometimes uncovers a finding that calls for an unplanned procedure — for example, a deeper debridement, a culture, or a referral for imaging. We will update your estimate or speak with you about new charges before performing care that was not in your original estimate, whenever the situation allows.

• If you schedule a visit at least 3 business days in advance: we will give you the estimate within 1 business day after you schedule.
• If you schedule a visit at least 10 business days in advance: we will give you the estimate within 3 business days after you schedule.
• If you ask for an estimate without scheduling a visit: we will give it to you within 3 business days of your request.

We can deliver the estimate on paper or, if you prefer, by secure email or through our patient portal.

Call us at 972-491-1200, email Info@DrRizviWoundCare.com

, or ask the front desk when you call to schedule. Tell us you would like a Good Faith Estimate and how you'd like to receive it.

If you receive a bill from any provider listed on your Good Faith Estimate that is at least $400 more than the amount that was estimated, you have the right to dispute the bill through the federal patient-provider dispute resolution process. You generally have 120 calendar days from the date of your bill to start a dispute.

For help or to start a dispute, you can:

• Visit CMS.gov/nosurprises/consumers for the patient-provider dispute portal and a step-by-step guide.
• Call the federal No Surprises Help Desk at 1-800-985-3059 (TTY 711).
• Email FederalPPDRQuestions@cms.hhs.gov
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We will not retaliate, refuse to see you, or change the care we provide because you have asked for an estimate or filed a dispute.

Save a copy of your Good Faith Estimate in case you need it later. You will need it to start a dispute if your final bill is much higher than the estimate.

If anything in your estimate is unclear, call our office before you receive care so we can walk you through it.

Billing & Patient Accounts

Dr. Rizvi Wound Care

7709 San Jacinto Place, Suite 100, Plano, TX 75024

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Phone: 972-491-1200

Email: Info@DrRizviWoundCare.com

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This page is informational and does not create a contract. Coverage, cost-sharing, and benefits are determined by your insurance plan and by applicable federal and Texas law, including the No Surprises Act (45 CFR § 149.610) and Texas Insurance Code Chapter 1467 (SB 1264). It supplements, and does not replace, our Notice of Privacy Practices, our Non-Discrimination & Accessibility Notice, and our Terms of Use.