• Co-Insurance

    This is the percentage of costs you are required to be for a covered health care service after you have met your deductible. For example, you may be required to pay 20%. Co-insurance charges may be applied to specific treatments are services, but not all covered services. It is important to check with your insurance company about co-insurance costs for each specific treatment you plan to receive.

    Co-Pay

    This is a fixed amount you pay for a covered health service after you have paid your deductible. Co-pays are collected at the time of the visit. The amount of your co-pay may vary by the type of provider, e.g. Primary Care, Specialist and Emergency visits will likely have different rates. This information will be printed on the front of your insurance card.

    Covered Benefits

    Covered benefits are the medical services that an insurance plan provides for a subscriber. Excluded benefits are those treatments and services are not covered by the plan.

    CPT Codes (Current Procedural Terminology) are codes used for medical, surgical, diagnostic procedures and services. Insurance companies use these codes to identify covered benefits and to establish reimbursement rates. CPT codes commonly used by our practice are shown under the Treatments header.

    Deductible

    This is the amount you must pay before the insurance company begins to pay for health services. The deductible is paid annually.

    Plan Types

    PPO (Preferred Provider Organization) plans offer the flexibility to go directly to any provider. However, if you chose an out-of-network provider, the insurance company will likely cover less of the care, and you will have a more significant share of costs.

    HMO (Health Maintenance Organization) plans require you to choose a primary care physician (PCP) for all referrals to specialists. These plans have lower premiums, but they do restrict your access to providers.

    POS (Point of Service) plans are a hybrid between HMO and PPO's. You will be required to choose a PCP but will have more flexibility to go to out-of-network providers.

    Each plan has its own terms and limitations, so be sure to check your plan to understand how it works.

    Provider: In-Network

    Providers who are contracted by an insurance company are referred to as network or in-network providers. Non-contracted providers are referred to as "out-of-network."

    You can request a list of contracted providers from your insurance company.

    Insurance plans periodically update their lists of in net-work providers. It is wise to double check coverage with both the plan and the provider before incurring medical expenses.

    Provider: Out-of-Network

    This provider is not contracted with your health insurance company. Receiving care from this provider, will result in higher costs to you or denial of coverage.

    If a network provider is not available to provide the care you need, the insurance plan may approve treatment by an out-of-network provider. These arrangements must be made in advance of receiving care. In some cases, the insurance company will approve out-of-network treatment at in-network rates. Be aware this is a potential option and one you can request.