No Surprises Act/Good Faith Estimate

Nobody likes to be surprised by the cost of their medical care. That is why it is important to understand the health insurance you carry to determine what your financial responsibility is for your medical care.  We are committed to sharing information in ways that will help you make informed decisions about health care services.  A component of the federal “No Surprises Act” is your right to receive a Good Faith Estimate explaining how much your medical care will cost if you are uninsured or are electing to pay for care without insurance.  A Good Faith Estimate will be emailed to all uninsured or self-pay patients at the time of scheduling their appointment.   As a patient, you have rights.  Upon receiving your bill, if the total costs exceed $400 from the 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. 

Moffitt Health Center Good Faith Estimate for Health Care Items and Services

• Description of the service:  Office Visit = CPT TBD
• Additional services:  Lab / x-ray / medication / procedure =  CPT TBD
• Diagnosis code:  ICD-10 code TBD
• Expected charges:  $20 office visit plus any lab/x-ray/medication/procedure cost TBD
• Facility Location: 2899 W 4th St. Hattiesburg, MS 39406
• Disclaimer Info:  This Good Faith Estimate is an estimate and subject to change. This estimate is not a contract, and there may be additional items or services not contained in the good faith estimate. You have the right to initiate a patient-provider dispute resolution process if the cost exceeds the Good Faith Estimate by at least $400.

No Pass Through Billing (Outside Lab Costs)

Any labs not ran on site in our Moffitt Health Center lab will be billed to the patient by the outside performing lab (Labcorp or Quest Diagnostics.)

Clinic

We currently accept and file claims for any healthcare insurance. Such as Aetna, Assurant Health, Blue Cross Blue Shield MS and surrounding states, Cigna, HealthFirst, Humana, Tri-Care and United Health Care in our clinic. We are not considered Network Providers for some of these carriers so be sure to check with your insurance carrier before seeing one of our providers. We are currently unable to accept Medicare, Medicaid, and CHIPS.

For those with Medicare, for help finding a Medicare provider, contact the Physician Finder Line at Hattiesburg Clinic at 601.261.3518.

Pharmacy

USM Pharmacy is currently able to accept the following insurances: Aetna, Advance PCS, Anthem, Blue Cross Blue Shield of Mississippi, Caremark, Caremark Federal, Catalyst, Catamaran, Express Scripts (Cigna), Humana, Medco, MedImpact, OptumRx, Paid, Prime Therapeutics, Rx Solutions, United Healthcare, and UMR.

Please note, this list may change without notice. 

Patients having health insurance will receive an EOB (Explanation of Benefits). This will be sent to the mailing address obtained by the health insurance carrier. Keep in mind, such mail may contain information on it that you consider private. Be aware that you have the option not to file services to your insurance company. This EOB will include coding for the visit along with the diagnosis. Patients have the right to ask 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.

Defined as:

• Patients not covered under any health insurance carrier.
• Patients that have health insurance that is a non-participating carrier of Moffitt Health Center.

Patient acknowledges that they are responsible for the payment of all services rendered, including pharmacy services, on the day of your visit.

You must provide Moffitt Health Center with a copy of your insurance card. Your insurance must be current. 100% of your services will be sent to your insurance carrier; you are only responsible for $20.00 provider fee on the day of the services. This 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.

Once payment is determined, (co-pays, deductibles, and non-covered services) faculty/staff members will receive a statement via mailing address or campus address. Students will see any remaining charge(s) on their SOAR account.
  
Payment must be made before the end of the semester in order to register for the next term, receive a transcript, or receive your diploma.

Patients having health insurance with a health insurance company that Moffitt Health Center does not participate with, are classified as Out of Network accounts. We will bill 100% of service charges to the insurance company; you are only responsible for $20.00 provider fee on the day of the services.

If the Out of Network insurance company does not cover all or any of the charges for the patient’s services, the patient will owe the remaining balance.

You must provide the USM Pharmacy with a copy of your insurance card. If they accept the insurance carrier, then they will process your claim in real time, and provide you with the co-pay. Patient acknowledges that they are responsible for the payment of the provided co-pay.

Graduate Assistant patients are required to have insurance coverage at USM. If you are participating with a separate insurance coverage, a waiver must be signed. If you do not sign the waiver, you will automatically be enrolled in the USM Student Insurance Plan. Please contact the Graduate Office at 601.266.4369 for more information. 

You must provide 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 USM Pharmacy with a copy of your card. Charges may occur from the pharmacy, depending on the medication. Ask the pharmacist or pharmacy tech before filling the prescription.

The USM Student Insurance Plan starts August 1st. Coverage is through United Healthcare. For more information on application, premiums, and coverage, please view the Insurance Summary Flyer. 

GA, RA, and International Students can find more information on the USM HR website. 

Note: Moffitt Health Center does not oversee the health plan. Administration of the policy is handled by USM HR Department.

Moffitt Health Center will not release any personal information without the patient’s handwritten consent. We cannot discuss any information to a parent, caregiver, friend, or anyone else requesting information without the patient’s consent. Consent forms are available at the check-in counter at Moffitt Health Center.

Financial information can be discussed without consent.

The patient or responsible party agrees to pay any portion of charges that are not paid by the patient or responsible party’s insurance company. The patient also acknowledges that they are responsible for the payment of all services rendered, if not paid by the insurance company.  

Employees: Balances not paid after 2nd notice will be deducted from payroll. 

Moffitt Health Center and USM Pharmacy are able to take the following forms of payment: 

• Cash
• Check (mail check payments to 118 College Drive #5066, Hattiesburg, MS 39406)
• Visa/Mastercard
  • If paying with a health savings account (HSA) card, please notify our front office staff at checkout. Clinic or pharmacy charges needing to be paid with an HSA card must be paid at Moffitt Health Center. 

• Bursar (charge to your student account)

Employees needing to make payments can call in their payments using a debit or credit card and we can send a receipt via interdepartmental mail. 

Students who choose to have their charges sent to their student account can make payments through the Business Office using the following methods: 

Online

• Login to SOAR. Click on Student Dashboard > Student Account > Make a Payment. (Pop-up 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