Understanding Your Insurance
Insurance plans vary widely in benefits and coverage. While our office makes every effort to work with patients regarding coverage, it is essential that you understand what insurance coverage you have and what you need to do to get the most from your health benefits. Health insurance is a contract between you and your insurance carrier – the medical provider is not a part of that contract. Most medical providers offer complimentary filing of medical claims as a convenience to patients. However, it is vital that patients review both the explanations of benefits (EOB) sent by your insurance plan as well as statements from the medical clinic. The first recommendation we make to patients is to know your benefits.
AFWC has partnered with Phreesia, Inc., an automated patient check-in system which connects live with major insurance carriers to provide real-time answers to common questions such as “Have I met my deductible?”or “What is my co-pay?”
Does AFWC Accept My Insurance Plan?
AFWC accepts all insurance except Medicare, TriCare/TriWest and Federal Worker’s Compensation. We are a preferred provider for Blue Cross Blue Shield and Aetna health plans.
While we do continue to provide care for established patients who age into Medicare, we are not currently accepting new Medicare patients for covered services. Medicare patients may be seen as self-pay patients for non-covered services such as allergy drops, prolotherapy and PRP.
TriCare/TriWest patients may be seen as self-pay and submit their own claims.
What is AFWC’s Payment Policy?
Why is There a Supplemental Payment Policy for Motor Vehicle Accident (MVA) Patients?
Patients receiving care for motor vehicle accidents are usually involved in insurance and even legal proceedings as a result of the accident. The insurance industry standard is to pay no medical bills until a settlement or court decision has been made. This means your healthcare provider can go unpaid for months – even years, in some cases. As a small clinic, we are simply unable to carry patient balances past 90 days.
Payment in full is required at time of service for all medical care provided as a result of a motor vehicle accident. This includes office visits, lab tests and in-office procedures. Copies of your medical and billing records are available to you at any time with a completed release of information form.
Common Insurance Terms
Co-pay: The amount a person with insurance is expected by their insurance plan to pay at the time of service once the patient’s deductible has been met. This can be a percentage of the total charge (example: 20% of office visit or lab fee) or a flat charge (example: $25.00 per office visit or lab fee). You will be asked to pay this at each visit once your deductible has been met.
Deductible: The amount of money a person with insurance is required to pay out of pocket before insurance will begin paying toward charges. The deductible must be paid at time of service.
Prior Authorization: Pre-approval of services by the insurance company. Many plans require this for mental health services and certain out-patient procedures. Failure to complete a prior authorization before treatment will delay payment or cause denial of claims. It is always best to contact your plan prior to scheduling any procedures to learn if a prior authorization is necessary. Our clinic works with patients to complete this process. Please remember, however, that no insurance company will guarantee coverage for any procedure even if it is pre-authorized.
Out of Pocket Maximum: The amount of money a person with insurance is required to pay out of pocket each year before insurance may cover fees at 100%. It is always best to verify this with your individual plan.
Yearly Benefit Maximum: Maximum amount the insurance company will pay per year per insured person.
If you still have questions or concerns, your best resource is your insurance carrier’s customer service department. Our staff can provide you with basic insurance information as there are literally thousands of plans available. Please call our medical biller Malynda at (907) 561-9444, ext. 4 or send us an e-mail.