You need to be aware that your policy is a contract. You should have a copy of your policy in its entirety. It is our recommendation that you read and understand your entire policy.
There are a number of different policies written (Indemnity, Preferred Provider Organization, Point of Service, Health Management Organization) and you need to know what your coverage is (annual deductible, co-insurance, maximum out of pocket expenses, lifetime maximum etc...). In some plans you can have in and out of network benefits known as a swing plan.
We are currently contracted with the listed insurances below and currently do work with many other carriers on an 'out of network' basis. In some cases, if your insurance carrier cannot provide necessary medical care within the network, the carrier will grant the policyholder a waiver (sometimes referred to as a 'Network Clinical Gap Exception') to go outside the network for treatment. The medical claim is then submitted and processed as if the policyholder stayed inside the network.
Each state has its own laws and regulations governing all types of insurance. You need to check with your State Insurance Department if you have any questions regarding your carrier. The Self-Insured Employer's responsibilities are different than your general group policy with a small business. Your State Insurance Department enforces the laws, as well as providing the public with information about insurance.
We work very hard to assist the patient in obtaining necessary authorization(s) required for treatment at our practice.
Effective July 1, 2011, we are accepting the following insurances:
Avmed-MCR (HP,PH,EN,PS) or Capitated (HM, M2)
BeechStreet-MCR or URC
CarePlus-manipulation covered ONLY/ABN
Cigna / Greatwest
Focus-COMM MCR and W/C W/C and PIP UCR
Physicians United Plan-Capitated manipulation only/ABN
Quality-Capitated manipulation only/ABN
Worker's Compensation (for the Wellness Center only)
All Auto Insurances
We accept LOP's
Please call us about your insurance if your plan is not listed here.