Understanding Insurance

We are out-of-network with Medicaid and Cigna. However, if you have out-of-network benefits with Cigna, we can submit claims on your behalf to help you maximize your coverage. To help reduce the financial burden on our patients, we accept the Cigna rates represented in the EOBs. For Medicaid, we do not process claims, but we can provide you with an invoice if you wish to submit it to your provider.

• Premium: This is the dollar amount that people pay insurance companies for coverage to see providers who've agreed to be in-network with them. The higher the premium, the better the benefits. The lower the premium, the more the financial burden lies with you.

• Deductible: This is the amount you pay out-of-pocket before your insurance begins covering costs. For example, if your deductible is $1,000, you must pay this amount before your insurance starts to contribute. The money you pay the insurance company each month in premiums don't apply to the deductible. So, the insurance company makes money off of your premium, and then keeps it by making you pay even more money before they pay anything. For example, if you have a $20 co-pay, but you have a $1000 deductible, and the service visit was $73.14, you'd be responsible for $73.14, not $20. You'd be able to pay your $20 co-pay after you've spent $1000 on healthcare charges that get sent to your insurance company.

• Co-pay: This is a fixed amount you pay for a service, such as $20 per visit, as determined by your plan. As mentioned previously, you would need to have paid off your deductible before you'd be able to pay a co-pay. The reason it's called a co-pay is because you are paying a fixed dollar amount of the total the provider or clinic is owed. For example, if the provider or clinic is owed $73.14 for a service visit, and you have a $20 co-pay, you pay $20, and the insurance company pays $53.14.

• Co-insurance: This generally applies to people who wish to use their out-of-network benefits. It is similar to a co-pay, except that a co-pay is a fixed dollar amount, while a co-insurance is a percentage of the costs you’re responsible for after meeting your deductible. Let's take the same example as above; if the provider or clinic is owed $73.14 and you have a 20% co-insurance, you'd owe $14.62 (20% of $73.14)

• Out-of-pocket maximum: This is the most you’ll pay for covered services in a year. Once you reach this amount, your insurance will cover 100% of costs for the remainder of the year. This amount is generally 200%-400% of what your deductible is. For example, if your deductible is $1000, your out-of-pocket maximum might be between $2000-$4000.

• Explanation of Benefits (EOB): This is a document from your insurance company that details the services you received, the amount billed, the amount covered by insurance, and any remaining balance you are responsible for.

• Your deductible status

• Co-pays or co-insurance amounts

• Any limitations on the number of visits covered

This allows you to make informed decisions about your care.

** This information is not always 100% accurate. We do our best to get accurate information as a courtesy, but at times, we've gotten incorrect information. Ultimately, the responsibility of knowing your insurance benefits is your own.

After your visit, we’ll submit a claim directly to your insurance provider. Once the claim is processed, you’ll receive an explanation of benefits (EOB) from your insurance company outlining what was covered and any balance owed. If there’s a balance due, we’ll send you a statement.

If you’re uninsured or prefer not to use your insurance, we offer affordable self-pay options. Our team can discuss pricing and packages tailored to your needs.

Q: What if my insurance requires a referral?

Some plans, such as HMO plans, may require a referral from your primary care physician. We recommend checking with your insurance provider before your appointment.

Q: Do you offer payment plans?

Yes, we can work with you to set up a payment plan if needed. Our priority is making care accessible and manageable for all our patients.

Q: How do I know what my insurance covers?

Our staff is happy to assist in verifying your benefits, but we encourage you to contact your insurance provider directly for the most accurate and up-to-date information. If you're curious what your insurance already covered, when a claim is submitted to insurance, both you and our clinic will be supplied with an EOB to inform you as well as our billing department.