We participate with many major insurance carriers including Aetna, BCBS, Cigna and Medicare, just to name a few. Patients should always check with their individual carriers to determine the network status of our office.
Insurance is a complex subject and constantly changing environment. Please note that your insurance may have an associated network of preferred providers, and as such, your benefits and potential out-of-pocket expenses may vary depending upon your specific plan. It is strongly recommended that you contact your plan before your visit in order to understand your potential financial liability.
Sometimes the patient’s assistance is needed in appealing to the insurance carrier for any services that are not paid. You can also assist by promptly responding to Coordination of Benefits (COB) requests that you may receive from your insurance carrier. Updating your coordination of benefits is the responsibility of the patient, not this office. Your prompt payment of any deductible, coinsurance and/or co-pay is also appreciated.
Insurance terms can be confusing, here is a basic list of common health insurance terms that all patients should know. There are numerous other terms and phrases that patients should understand, but this list is a good place to start.
Premium = The financial amount that a patient must pay in order to gain access to a health insurance plan.
Deductible = The price that people pay for access to health care services before their insurance plans start to cover any cost. If a person chooses to pay a higher deductible, this generally means a lower premium.
Copay = The amount that a patient has to pay upfront for a healthcare-related service or treatment. The rest of these expenses are usually covered by their insurance plan.
Coinsurance = The percentage of any medical bill that patients must pay, due to hospitalizations or similar treatments, after their deductible has been met.
Formulary = Also called a drug list, this is a list of the prescription drugs that a person’s insurance plan covers. If a physician prescribes any medication, not on the plan’s formulary, the person will have to directly pay (out of pocket) for the medicine.
Provider = Any healthcare professional or institution.
In-network = A situation where the healthcare provider is contracted with a patient’s insurance plan to accept a set amount of money for specific treatments.
Out-of-network = A situation where the healthcare provider is not contracted with an insurance plan. In this case, our office has out-of-network fees that are paid at time of visit.
Additional terms and their definitions are available at the U.S. government’s Bureau of Labor Statistics website