A co-pay is a dollar amount that insured Members must pay up front before being seen for a consultation (PCP, Specialist, Urgent Care and ER)
What is a deductible?
A deductible is a dollar amount that insured Members must satisfy before their policy will start covering them. Only covered services will apply towards the deductible.
What is a co-insurance?
The co-insurance is a percentage (i.e. 10 %) the insured Members would be responsible to pay after the Insurance has paid their portion of the bill (90 %)
What is a PPO plan?
PPO stands for Preferred Provider Organization. If you have a PPO plan you do not need a referral to see a Specialist and you may have different benefit levels for out of network providers.
Do I need a referral to see a specialist?
No, because you have a PPO plan.
What is an Urgent Care Center?
An Urgent Care Center is a walk-in clinic where you can see a Primary Care Physician without an appointment. Urgent Care Centers are convenient because they are usually open early in the morning until late in the evening, and often on weekends. Urgent Care Centers may also be equipped to perform X-rays and/or CT scans. Please note that specialists (cardiologist, ENT, GI, etc.) are not available through Urgent Care Centers.
What insurance information do I need to give to my healthcare Provider when making an appointment?
Inform them you have a PPO plan and provide them the contact info that appears on your insurance ID card so they can get in contact with us and we will verify eligibility and benefits.
What services require prior-authorization?
Any services considered invasive such as outpatient surgeries, hospital admissions, treatment of a catastrophic diagnosis, specialty drugs and injections. Please always verify with your insurance as there may be additional services requiring a prior-authorization based on the type of policy you have.
Are Providers allowed to charge me for a copay/deductible/co-insurance before receiving the healthcare services?
Providers are only authorized to charge you up front (before the medical service) for a co-pay or a deductible. Please contact us should they try to charge you for a co-insurance after receiving your medical care.
Can I see a Provider that is not part of the Network I have access to?
You can as you have a PPO plan, however check with your insurance to confirm the benefits for going out of network as they may be different than your in network benefits.
Do I need to call you before going to the doctor/urgent care/hospital?
You only need to notify us if you are going to have a service that requires a prior authorization. Always provide your insurance ID care to your healthcare provider so they may call us for any questions about your benefits.
What should I do when I receive a bill from the Provider?
It is very common that providers send a bill to patients instead of the insurance even though they had your insurance information. Do not panic. Contact us so we may review a copy of the bill.
What should I do if the Provider informs me they are not contracted with my insurance?
Contact us to verify your out of networks benefits and we can also assist you in finding an alternative, in-network provider.
