Basic Insurance Information
Our
Urologists are participating providers in many insurance plans and networks.
Every insurance policy is different and policies vary in coverage details
. You may refer to our participating insurance list for currently accepted insurance plans and networks. Note that the information listed may change without notice. If you have any questions please ask our staff for final confirmation of our current network and participation status.
Our office will bill your insurance company on your behalf and accept payment from the insurance company for the plans in which we participate. Please appreciate that any co-insurance, co-payment and deductibles are your direct out-of-pocket responsibilities, as are any other amounts which your insurance plan indicates in their Explanation of Benefits. For specific details, please contact your Insurance Plan directly.
Insurance Plan Types
PPO Plans usually provides the highest level of coverage when visiting a network doctor. This type of policy tends to be more flexible when it comes to receiving tests and treatment at the doctor's office. For the most part with a PPO plan you can visit any network provider without having to get authorization from your insurance. For the majority of patient visits, this policy type has a small co-pay, which is required at the time of service. Other variations of this policy type have a percentage-based patient responsibility. This is indicated at the time the claim is processed by the insurance. Note that if you visit an out of network doctor, your insurance might limit the benefits or not provide any benefits at all. Be sure to verify with your insurance company the details of your particular policy. You may also verify by calling our office and learning of our current network status.
Managed Care Plans are usually policies which provide services that are managed by the insurance plan. This policy type is generally more network dependent. The plan usually revolves around a Primary Care Provider (PCP). In case of HMO policies, the patient will normally have to get a referral or authorization from his PCP to visit a specialist doctor, like our doctors. Occasionally, the patient might need to get an authorization from the insurance company itself. For this kind of policy, in office services are usually limited. Managed care insurance companies often have designated Imaging Providers (Radiologists) as well as Laboratory Providers (blood and pathology tests) for its HMO policy holders. Any of these services MUST individually be authorized by the insurance plan in order for the specialist to perform them. Once these prerequisites are met, the patient is responsible only for a co-payment at the time of service. Out of network benefits are normally minimal or non-existent with a direct HMO plan. Please note that the patient is responsible for getting the necessary referrals or authorization. An inability to do so will result in a delay of the appointment until the insurance requirements are met. However, if the patient chooses, he/she can have complete financial responsibility for the services. A variation of the HMO policy referred to as POS (Point of Service) allows patients to see specialists without getting referrals or even see some out of network Doctors. This is attractive yet the patient will often be responsible for higher co-insurance payments and deductibles.
Indemnity policies are not usually bound by network restrictions. The insurance plan will normally pay a predetermined percentage of the allowed fee. In case of network doctors, the patient will be responsible for a lower percentage after his deductible has been met for the year. When in network, our office will abide by the contract rules as with any other policy type that we might belong to. Indemnity policies have the most freedom of choice for the patient yet they often have a higher patient out of pocket responsibility. This policy type generally does not require authorization for most in office procedures. Be sure to call your insurance to verify the intricacies of your particular policy or refer to your policy manual, also verify by calling our office for our current network status.