Insurance Coverage

Many people would like to know what insurance coverage they might have when seeing one of our providers.

OFFICE VISITS

For office visits with our providers, we are considered an out-of-network provider. When a practice chooses to accept insurance, insurance companies dictate how much time they can spend with each patient, what illnesses and conditions they can treat, and how they can treat them. To get to the root cause of the problem and provide the best treatment, we need more time with our patients and more treatment options than insurance companies are willing to work with. 

If you have a PPO plan, insurance companies will often reimburse you for much of your office visit costs. You will pay for the appointments at the time of service and then file the necessary paperwork for reimbursement with your insurance provider. 

If you are on an HMO plan, most likely, your insurance will not cover any of the costs of your office visits but will likely cover all or a majority of your lab work.

To find out your insurance coverage, we encourage you to call the customer service number on the back of your insurance card and ask a few basic questions. Tell them you’re going to see an out-of-network provider. Ask what the deductible is and what percent they will reimburse for the office visit with an out-of-network provider. 

LAB WORK

If your insurance provider does not offer to cover most of the lab work or if it is being applied to your deductible, we offer a discounted lab program through Quest Diagnostics and LabCorp.

We have always encouraged our patients with insurance coverage to pay for their lab work through their insurance providers. In the past, most insurance plans would completely cover labs, regardless of the deductible, or only require the patient to pay a co-pay or 10% to 20% of the invoice. 

Many insurance companies are moving from that model, and in many cases, only paying after a deductible is met. Even after the deductible, they may only cover 80-90% of the invoice, and patients are billed the rest. With many annual deductibles of $5000 or more, it can be costly for patients to pay out of pocket for the cost of their lab work until their deductibles are met. 

With this information in mind, it is important to find out from your insurance company if they will cover your lab work before having them drawn. Share your lab requisition with your insurance company and inform them your out-of-network provider is ordering comprehensive lab work. Ask them specifically what percentage of the lab costs they will pay. 

You are better off using your insurance if it is 90-100%. If labs are only covered at 75% or less, you will be better off using our self-pay discounted lab program available through Quest Diagnostics or LabCorp. 

Please call us for additional information, including general lab pricing.

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