Insurance Information
Insurance Accepted
We accept a variety of different insurance carriers. Please call and verify your coverage with us before scheduling an appointment. If you have an insurance that our office participates with, we will submit your claim for
you. Your co-payment is due at the time of your service.
If we do not participate with your insurance plan, payment in full is expected at the time services are
rendered. For your convenience, Visa, MasterCard, Discover, American Express, personal checks and
cash are accepted.
Insurances in which CEC participates
AETNA - HMO/PPO
AETNA - MEDICARE
ANTHEM – HMO/PPO
BEECH STREET - PPO
CAREFIRST - PPO/HMO
CIGNA - PPO
COMPASS ROSE HEALTH PLAN
FIRST HEATLH - PPO
GREAT WEST - PPO
HUMANA - CHOICE CARE PPO
HUMANA - GOLD CHOICE
KAISER OPEN ACCESS
MEDICARE PART B
PHCS – PPO
TRICARE STANDARD
TRICARE FOR LIFE
UNITED HEALTH CARE MAMSI LIFE
UNITED HEALTH CARE MDIPA HMO
UNITED HEALTH CARE OPTIMUM CHOICE HMO
UNITED HEALTH CARE PPO
UNITED HEALTH CARE ONE NET PPO
UNDERSTANDING YOUR INSURANCE COVERAGE
Your insurance policy is an agreement between you and your insurance company. The policy lists a package of medical benefits such as tests, drugs and treatment services. The insurance company agrees to cover the cost of certain benefits listed in your policy. These are called “covered services.”
Your policy also lists the kinds of services that are not covered by your insurance company. You have to pay for any uncovered medical care that you receive. Keep in mind that a medical necessity is not the same as a medical benefit. A medical necessity is something that your doctor has decided is necessary. A medical benefit is something that your insurance plan has agreed to cover. In some cases, your doctor might decide that you need medical care that is not covered by your insurance policy.
Insurance companies determine what tests, drugs and services they will cover. These choices are based on their understanding of the kinds of medical care that most patients need. Your insurance company’s choices may mean that the test, drug or service you need isn’t covered by your policy.
There are so many different insurance plans that it’s not possible for your doctor to know the specific details of each plan. By understanding your insurance coverage, you can help your doctor recommend medical care that is covered in your plan.
- Take the time to read your insurance policy. It’s better to know what your insurance company will pay for before you receive a service, get tested or fill a prescription. Some kinds of care may have to be approved by your insurance company before your doctor can provide them.
- If you still have questions about your coverage, call your insurance company and ask a representative to explain it.
- Remember that your insurance company, not your doctor, makes decisions about what will be paid for and what will not.
- Remember that your physician, not your insurance company, makes medical decisions and recommendations about what will benefit your health status.
Most of the things your doctor recommends will be covered by your plan, but some may not. When you have a test or treatment that isn’t covered, or you get a prescription filled for a drug that isn’t covered, your insurance company won’t pay the bill. This is often called “denying the claim.” You can still obtain the treatment your doctor recommended, but you may have to pay for it yourself.
If your insurance company denies your claim, you have the right to appeal (challenge) the decision. Before you decide to appeal, know your insurance company’s appeal process. This should be discussed in your plan handbook. If during the appeals process there is some supporting documentation from our office that would be helpful to you, please don’t hesitate to discuss that with our Billing Representative.
Source: American Academy of Family Physicians, 2001
