Frequently Asked Questions
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).
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.
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 %).
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.
No, because you have a PPO plan.
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.
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.
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.
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.
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.
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.
Contact us to verify your out of networks benefits and we can also assist you in finding an alternative, in-network provider.
