Frequently Asked Questions

Frequently Asked Questions

If you have any other questions not listed here, please fill out the Contact Us box on the right side of the page and we can further answer your questions.

  • Can I make an appointment if I don't have health insurance? 
    Yes, you can be seen by our doctors as a self-pay patient and will be charged according to the services rendered.
  • Will Medicare cover all of my medical treatment?
    After your deductible has been met, Medicare will pay 80% and the patient pays 20%. If you have additional secondary insurance, your payment will be less than the 20%.
  • What is the Medicare deductible for 2015?
    $147.

Health Insurance Terms

Understanding health insurance terminology can be difficult. Below is a list of common insurance terms to help you better understand your coverage.

  • Co-insurance: in indemnity, the amount to be paid by the patient, usually a percentage of charges.
  • Co-payment: in managed care, the amount to be paid by the patient, usually a dollar amount.
  • Deductible: the portion of medical costs to be paid by the patient before insurance benefits begin, usually expressed in dollars.
  • Denial: when insurance refuses to reimburse for medical services; can be for various reasons.
  • Eligibility: the process of determining whether a patient qualifies for benefits, based on factors such as enrollment date, pre-existing conditions, valid referrals, etc.
  • Exclusions: services that are not covered by a plan.
  • Flexible spending arrangements (FSAs): an account that allows employees to use pre-tax dollars to pay for qualified medical expenses during the year. FSAs are usually funded through voluntary salary reduction agreements with an employer.
  • Health maintenance organization (HMO): a form of managed care in which you receive your care from participating providers.
  • Health savings account (HSA): a savings product that serves as an alternative to traditional health insurance. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.
  • Managed care: a method of providing health care, where the insurer and/or employer (policyholder) maintain some level of control over costs and utilization by various means. Typically refers to HMOs and PPOs.
  • Member: a term used to describe a person who is enrolled in an insurance plan; the term is used most frequently in managed care.
  • Non-participating provider: any health care provider or organization that does not have a contractual agreement with an insurance company to provide care to eligible patients for a contracted or discounted fee. Patients can receive services from non-participating providers if they have out-of-network benefits as a part of their insurance plan or if they wish to pay cash for the service but they will miss out on in-network discounts. (Same as "out of network provider").
  • Open enrollment: a set time of year when you can enroll in health insurance or change from one plan to another without benefit of a qualifying event.
  • Out-of-pocket: money the patient pays toward the cost of health care services.
  • Participating provider: a health care professional or organization that has a contractual agreement with an insurance company to provide care to eligible patients under certain defined conditions and often at discounted and/or contracted fees. (Same as "in network provider").
  • Payer: the party who actually makes payment for services under the insurance coverage policy. In the majority of cases, the payer is the same as the insurer. But, as in the case of very large self-insured employers, the payer is a separate entity under contract to handle the administration of the insurance policy.
  • Policyholder: purchaser of an insurance policy; in group health insurance, this is usually the employer who purchases policy coverage for its employees.
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  • Preferred provider organization (PPO): a form of managed care in which the member has more flexibility in choosing physicians and other providers. The member can see both participating and non-participating providers. There is a greater out-of-pocket expense if a member sees non-participating providers.
  • Premium: the cost of an insurance plan shared by employer and employee.
  • Provider: one who delivers health care services within the scope of a professional license.
  • Reimbursement: refers to the payment by the patient (first-party) or insurer (third-party), to the health care provider, for services rendered.