Frequently Asked Questions

Billing

Why doesn’t Summit authorize prepayments?
The goal of a prepay request is to ensure payment. But, because you have a contracted agreement with Heritage Summit HealthCare, your payments are already contractually agreed upon, making prepay requests unnecessary and can actually slow down the bill payment process.

Why can’t I bill a second opinion as an IME?
The state of Florida has a very specific definition and protocol for use of a free change of physician, an independent medical evaluation (IME) and a second surgical opinion.

  • Free Change of Physician—A free change is a complete transfer of care.
  • Independent Medical Evaluation (IME)—An IME is a specialized evaluation used primarily in court if a claim is litigated. It is a highly extensive and specifically formatted patient case review. It must be completed by a physician who has never seen the patient and is not affiliated with any physician who has. Summit is allowed one IME for the life of a claim, and the injured worker is allowed one.
  • Second Surgical Opinion—The state of Florida doesn’t recognize the term “second opinion” for legal purposes, but we are allowed to request a second surgical opinion as part of our managed-care plan. This is just a review of the patient’s case by another physician to determine if surgery is necessary.

The answer to this question is based on Florida laws. Definitions and statues may differ by state.

How does Summit base bill payment?
Because our network encompasses a wide range of providers with various specialties and locations, they are paid based on their individual contract agreements. If you are an in-network provider, contracts are negotiated on a case-by-case basis. To find out how your bills are paid, check out the fee schedule (Attachment A) in your contract or call your network representative.

¹ Article V, Section T. PROVIDER agrees not to require prepayment of any services provided under this AGREEMENT.