Insurance Billing

Green-Accent-Dots

When you schedule your initial visit and complete your new patient paperwork, I will verify your insurance benefits and let you know what kind of coverage your plan will provide.

Some insurance plans require prior authorization for specific treatments, and some require a referral from your Primary Care Home.  We will talk about the specifics of your plan once I’ve had a chance to speak with your insurance company.

Some insurance terms can create a bit of confusion, so here are the details of some terms:
  • Copay – The amount you are required to pay upfront for an office visit.  If and when you meet the out of pocket maximum, most plans will then waive your copay.
  • Deductible – The amount of money your insurance requires you to pay for your healthcare before they begin to pay their contracted portion.  This one can get tricky though.  For most plans, your deductible does not need to be met for office visits but will come into effect for labs, treatments, and imaging, but this isn’t always the case.  Many plans have an individual as well as family deductible, this is helpful if one member of the family tends to use their health insurance quite a bit while others don’t.
  • Coinsurance – The percentage of your health care you are required to pay.
  • Out of pocket maximum – The maximum amount you will need pay for your health care each year.
  • Referral – If a referral is needed, your primary care provider will need to go through your provider’s unique referral process to ensure your care will be covered by a specialist like myself.
  • Prior Authorization – This is when a treatment or evaluation must be approved before you start therapy.  Your insurance may decide that the care you would like to receive isn’t “medically necessary” and deny payment.  It is always advisable to wait for this decision before starting any treatment to avoid large unexpected bills.
Companies I am currently contracted with:
  • Aetna
  • Blue Cross
  • Providence
  • Cigna

 

  • Care Oregon
  • ASH
  • Pacific Source
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