We make every effort to keep this list as accurate as we can. Even so, it is possible that not every health plan and circumstance is addressed here. You can obtain the most accurate and timely information by calling your health plan or employer benefits department and confirming your coverage level when choosing our doctors.
FAQ about Health Plans
Q. What type of yearly exam do I need? A. Our office offers two types of yearly evaluations. Our Comprehensive Evaluation involves a complete history, review and treatment of any problems or symptoms, bloodwork, and a complete physical examination. If you are on any chronic medications or have any problems to discuss with the doctor, this is the kind of visit you should have. The Preventive Physical is much less involved and covers only review of preventive tests, bloodwork, and a complete physical examination. If during your Preventive Physical an abnormality is identified on your exam or bloodwork, you will need another visit on another day to address it. If your insurance company treats these kind of evaluations differently (fully paid for or does not go towards your deductible) and you have no medical concerns or medications, you may choose this option.
We use the diagnosis code V70.0 (Health check-up) for Preventive Physicals. You may wish to contact your insurance company to see how they cover these codes. Health insurance benefits are changing rapidly. They differ not only from one insurance to another, but within policies in a single insurance company. As a result, the office is not responsible for knowing the details of an individual’s contract with their insurance company. All liability for policy-mandated benefits resides with the policy holder.
The amount of time we allot to each differs so it is helpful to us to know ahead of time what services we will be rendering. Please call us as soon as possible if you only want a Preventive visit. If you do not specifically request the Preventive Physical, we will do our Comprehensive Evaluation.
Q. You don't participate with my insurance. What happens when I come to your office? A. You will pay for your visit at the time of service. We will submit your claim for you to your insurance company. You will be reimbursed by your insurance company based on your out of network coverage.
Q. What is an insurance copayment? A. A copayment, copay or encounter fee is the amount of money your insurance plan requires you to pay at the time of your visit.
Q. Am I required to pay a copayment every time I visit the office? A. Generally, our staff will collect a copayment every time you see the doctor for an office visit. Insurance company rules regarding copayment collection for lab work, immunizations, office surgeries, etc. vary depending upon the type of insurance involved.
Q. My insurance plan has a deductible and co-insurance. How will I know what I am required to pay? A. Any insurance plan deductible and co-insurance is the patient's responsibility. You will receive a bill from us after we have received your insurance company's payment. You should also receive an Explanation of Benefits from your insurance company which will indicate the patient's financial responsibility.
Q. Why did I receive a bill when I paid my copayment at the time of my visit? A. There are a number of different reasons you could receive a bill from us in addition to your copayment. Some insurance plans require a deductible for laboratory services, immunizations, minor surgical procedures or hospital visits, etc. In that case, you would be responsible for any charges put toward your deductible. Not all insurance plans cover preventative care services, i.e., annual physicals, immunizations, EKGs. Therefore, any charges for these services would be the patient's responsibility. Some insurance plans require you to select a primary care physician. If you have not done this, your insurance company will consider your visit to be "out-of-network", even though we participate with your plan. Your insurance plan may not cover visits for obesity, pre-employment exams, school or sports physicals, cosmetic removal of moles and lesions, or any other diagnosis they deem not medically necessary. Q. Both my spouse and I work and have dual coverage through our employers. Why can't I decide which plan I want to use? A. The insurance industry developed an industry wide agreement which determines which plan pays first. Generally, the plan covering the patient as the employee pays before the plan covering the patient as the dependent spouse. Therefore, your employer's insurance plan would be primary for you and the coverage through your spouse's employer would be considered secondary.