Others

We are not in network with the following but have worked well with them in the past

We are willing to work as out of network providers when necessary.

In General PPO's provide the best coverage and offer the most flexibility.

POS's are good as well but they often require that you utilize an in-network doctor. Also many services that you might consider standard are often excluded.

HMO's are becoming less and less accepted by doctors due to their extremely low reimbursement rates.

EPO's are pretty much the industry's new version of an HMO with little to no improvements.

 

 

 

 

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Uncooperative Networks

We are unable to work with

Humana

Coventry

Medicaid

Medicare.

 

 

 

 

 

 

 

In-Network

Dr Smith is an in-nework Provider with:


• BlueCross/Blueshield (PPO)
• PHCS (PPO)
• United Healthcare (PPO & POS)
• Cigna (PPO & POS)

Terms Defined:

  1. Deductible: This is the amount of money that an insurance company expects you to pay before they will cover any applicable charges. The cheaper the premium on a plan plan, usually the higher the deductible.
  2. Co-Pay: The amount you are expected to pay at the time of service. If you have not yet met your deductible, most providers will bill you for the balance of the day's charges..
  3. Visits/Calendar Year: The number of visits you are allowed per year for a given type of service. This is most applicable to chiropractic, physical therapy, and other types of long-term rehabilitative care.
  4. Out of Pocket Maximum: The maximum cash value that you would be expected to pay per year before your insurance covers charges at 100%. This comes in to play when you get really sick and have to use your plan a lot in any given year.
  5. Co-Insurance: Some plans rather than having a set copay will expect the patient to pay a percentage of the bill. For example, your plan may cover at 80%, and then you would be responsible for paying 20% of the charges.
  6. Maximum Lifetime Benefit: The maximum over the course of your life that the insurance company would be expected to pay. It is usually several million and only becomes a factor when you have a debilitating condition requiring life-long care. (e.g.. brain damage following a motorcycle accident).