Frequently Asked Questions

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If your claim has not been denied for any reason, there is generally a deductible associated with your insurance policy

The deductible is the amount of expenses that must be paid out of pocket before an insurer will pay any expenses. For example, if you have a $5,000 deductible per year, you must spend $5,000 in claims before your insurance starts paying on any remaining claims beyond $5,000. The deductible may not apply to all services; please refer to your individual insurance carrier for more information. 

A copay is a set rate you pay for prescriptions, doctor visits, and other types of care. Coinsurance is the percentage of costs you pay after you've met your deductible

Your deductible begins at the start of your plan year. Most plan years begin either January 1 or July 1, but plans can start on any date. (The Medicare plan year begins January 1) 

We are in-network with a variety of insurance companies that pay various amounts for the same services. The adjustment that you see is your insurance company adjusting our contracted rates with them. The allowed amount on your Explanation of Benefits (“EOB”) is based on the fee schedule set by your insurance company, not by our office. If you have questions about the pricing, please call the customer service number on your insurance card.  

Referrals are only required in our office if specified by your insurance company. Please contact your individual plan to determine if your plan requires a primary care referral for a specialist office visit. 

Insurance companies KNOWN to have referral requirements: 
1. Tricare Prime 
2. Humana Medicare HMO 

COB is used by insurance companies to establish the order in which health insurance plans pay claims when more than one plan exists. Sometimes the member has had previous health insurance coverage with another insurance plan/company. 

Often insurance companies will require that patients update COB even though they only have coverage with one plan. It is important to do this every time it is requested by your insurance company. Otherwise, all subsequent healthcare claims will deny and become the patient's responsibility. Some insurance plans require COB updates as often as every 6 months. It is common to have to update coordination of benefits if you have had any other insurance plan within the past 2 years. 

The fastest and easiest way to update COB is to call the customer service phone number on your insurance card. Some insurances send out paperwork to complete but calling them directly will speed up the process. Simply let the customer service representative know that you need to update Coordination of Benefits.