Insurance Matters


A reality of today's health insurance is that most insurance companies do not cover 100% of medical charges.  Most patients are responsible for a copayment or deductible which we ask you to pay at the time of your visit.  If your insurance carrier is one with whom we participate, we will bill the carrier after your visit directly.  If your insurance carrier is one with whom we do not participate, you will be asked for payment in full at the time of your visit.  Since we do not want the issue of payment to keep you from taking good care of yourself, payment arrangements can be made through the business office with Sandra Baker when necessary.

We bill your insurance carrier our usual and customary rates which are competitive with physicians of the same specialty in our area.  Insurance carriers, however, have their own methods of determining standard "allowable" charges, which at times are lower.  You will be expected to pay your co-pay on the day of service.  We except cash, check, credit and debit cards, including visa, MasterCard and Discover card.  We do not accept American Express.

Coverage issues

A periodic physical is the centerpiece of your overall health care and is recommended every 1-3 years depending upon your age and health status.  Fortunately, almost all commercial, Medicare, and the Affordable Health Act mandate coverage for the periodic physical portion of your visit. Some now do not pay for illness visits. You are responsible for knowing which services are not covered. The annual wellness visits are covered only once a year, often one day later than the previous year. If you had a physical on March 11th last year, and schedule one this year for March 9th, it will not be covered by Medicare.  Commercial insurers often cover if the visit is in the same month as before.

If you schedule a physical or medical visit, and after the fact, find out you are not covered, you are responsible for the payment.  We are always happy to help you understand your coverage or provide medical information if you wish to contest any bill, but for medical/ethical reasons, we can never alter or change the medical record or code to enhance reimbursement.

For the record

New insurance, new home, new name?  We want to know all about it.  Each time you schedule an appointment, you will be asked for updated information.