Insurance

 

Insurance Made Easy

Our benefits coordination and claims filing experience can help you get the most from your health insurance benefits. Because we’re experts at filing health insurance claims, you don’t have to be!

Self Pay Options

No health insurance?  We offer several Self-Pay options with flexible and affordable payment terms.

Insurance Plans

We accept most major insurance plans in addition to Medicaid and Workers’ Compensation. For questions regarding the use of your insurance benefits at our practice, please contact us.

FAQ’s

What does “coinsurance” mean?

Coinsurance is the shared payment by the insurance plan and you after the deductible is satisfied.   A common coinsurance is a 80/20 plan.  The plan will pay 80% of covered medical expenses the patient will pay the remaining 20% of covered medical expenses.

What is a co-payment?

Most insurance plans have a “co-pay” benefit for office visits and certain other types of medical services.  The co-pay is a set amount you will pay when going to see a physician.

I paid my co-pay at the time I saw the doctor and still received a bill. Is this right?

If the physician performed other services during your exam such as a laryngoscopy you may be required to pay more for services rendered.  Some services are considered surgical procedures even when performed in the physician’s office.  These services are put into a separate category of service and charges may be subject to the deductible not   “co-pay.”

Do I have to meet my deductible before I see a physician?

Not usually.  If you have a co-pay amount for physician office visits, you do not have to meet the deductible for office visits.  If your plan does not give you options for “co-pays” you may be required to meet your deductible for seeing the physician.

If I have two insurance plans for my child, does it matter which one gets filed first?

The “birthday rule” applies here.  It states that the parent whose birthday falls earlier in the year will be primary.  If parents share a birthday the plan that has been in effect the longest will be primary.

What is a “pre-existing” clause?

When you have a new group health insurance plan, you may be subject to an exclusion of benefits for certain conditions.   Your insurance plan will give you the specific details if you are subject to a “pre-existing” clause.  Your physician’s office will not be given specific information because of privacy rules that apply to disclosing protected health information.

Is there anything I can do about “pre-existing” exclusions on my insurance plan?

Yes in most cases.  Your insurance plan will instruct you on what steps you can take to remove pre-existing clauses from your policy.  Often it is necessary for you to provide proof of previous insurance coverage to waive pre-existing clauses from your current health insurance policy.

This information is not specific to any insurance plan or employer group.  Please consult your insurance plan or employer for detailed information regarding your health insurance policy or benefits.

My allergies are gone.  My sinus problems are gone.  Both thanks to Dr. Jason Sigmon.

Jennie Lovel

Patient