Insurance Explained

 Here's some things you need to know about your insurance coverage in our office.

• We are listed as a specialist with insurance plans.
   
• IN-NETWORK versus OUT-OF-NETWORK participation status.   This is important!
• When a provider is contracted with an insurance, they are considered in-network, or a  participating provider. 
• When a provider is not contracted with an insurance, they are considered out-of-network, or a non-participating provider. This means you will have zero benefits or limited benefits for services provided. It is your responsibility to check with your insurance company for details and limitations for out-of-network services.

PLAN TYPES:   Know your plan. This is really important too!
) It is your responsibility to verify your out-of-network benefits with your plan. 

PPOs - Preferred Provider Organizations:   If we participate - ok.   If we do not participate - it's still ok.
The plan prefers that you use an in-network provider, but they will pay for out-of-network services. Be prepared to pay more for out-of network services. No referrals required. Please verify coverage with your insurance.

POS - Point of Service:  If we participate - ok.   If we do not participate - no benefits. 
You will need to get care from a provider within the network. You will need a referral from your primary care doctor to see a specialist within your network.  

HMOs - Health Maintenance Organizations:   If we participate - ok.  If we do not participate - no benefits.
You will probably be limited to using in-network providers if you expect to have any benefits. And you will probably need a referral to see a specialist.

EPOs - Exclusive Provider Organizations:  If we participate - ok.   If we do not participate - no benefits. 
They want you to exclusively use in-network providers.   

Does your insurance require a referral to be seen by a specialist?
If you are not sure if you need a referral, please contact your insurance company. They can help with that. REFERRALS:  If your plan requires that you get a referral,  you are responsible for requesting the referral from your primary care physician, and for making sure that we receive the referral prior to your visit.  You can either bring your referral with you or ask your primary care physician to fax it to 314-434-1112.