NYSDOH STD Billing Guidance to Promote Confidentiality Page 8
At intake:
Starting [Date], this clinic charges a nominal fee for STD/HIV testing. You can pay by using health
insurance or a set fee based on your income. Do you have insurance that you would like to use?
If Client DOES NOT HAVE INSURANCE
Please know that your insurance company
is required to send an “Explanation of Benefits”
letter to the insurance holder. The letter is sent to
the policy holder, who may not be you. It may be
your parent/guardian, a domestic partner or a
spouse. If you are concerned about this person
finding out about this visit, you may want to pay a
set fee instead of giving your insurance
information.
The letter may tell what types of tests and
procedures were done at this appointment. The
letter does not include test results, although if you
get treatment for some STDs like genital warts,
that may show up.
Some companies use number codes, but
other companies may also use names like “STD
testing.”
This is a federal law that may put the
confidentiality of your testing at risk. Would you
still like to use your insurance?
Okay, we also have a sliding fee scale that
we use to determine how much a visit will cost. It is
based on your income and the services that you
get. You may not owe anything but we will provide
you with an idea of what you might have to pay.
After you see the [DOCTOR/NURSE] and get tested,
you will need to come back here so we can find out
how much you owe. Generally, most clients pay
[insert range of sliding fee scale for typical STD
testing service(s) for similar patients].
Note to staff: if a client is a minor, they should
only use their personal income.
[AFTER THE VISIT]
Based on the procedures provided, staff will
identify the cost. If the patient cannot pay the full
amount, assess the cost based on the client’s
income. If the client cannot afford the sliding fee
cost, services cannot be denied.
If Client STILL WANTS TO USE INSURANCE
If Client DOES NOT WANT TO USE INSURANCE
• Follow agency procedures regarding insurance
information collection and billing.
Note to staff: If the client refuses to give insurance information, income information, refuses to pay, or
cannot afford to pay, services must still be provided. Depending on a clinic’s policies, staff may provide
the client with a printed invoice and a return address envelope so that the client may mail payment at a
later date. It is not recommended to send follow-up notices, bills, etc., to the client’s address, to protect
the client’s confidentiality.