Insurance Questions
Q. WHAT INSURANCE COMPANIES DO YOU ACCEPT?
A. We accept most Insurance companies including the following:
Some insurance companies require an authorization (referral) for your visit to our office. Please check to see if your insurance company requires an authorization. This authorization needs to be sent to our office before the day of your appointment by your primary care physician. Remember, you are responsible for any deductible, co-insurance or other balance not covered by your insurance company
- AETNA
- APWU
- BCBS OF NORTH CAROLINA
- FIRST HEALTH NETWORK
(CCN was renamed to First Health - includes Principal)
- CHAMPUS
- CIGNA HEALTHCARE
(includes Great West Life)
- HEALTHCARE SAVINGS
(includes many insurance companies)
- HUMANA
- MAILHANDLERS
- MEDCOST
(includes Principal)
- MEDICARE
- Partners
(Medicare Advantage Plan)
- PRIVATE HEALTHCARE SYSTEMS
(includes many insurance companies, including Principal)
- TRICARE
(not Tricare Prime)
- UNITED HEALTHCARE
(includes Alliance PPO, Mamsi, Secure Horizons, Evercare, One Net PPO)
- WELLPATH
(A Coventry Health plan)
- BEECHSTREET
Q. WHAT IS CO-PAYMENT?
A. A co-payment is a flat fee that your insurance company has determined is due from, you, the patient at the time of each office visit. It can also, depending on your insurance, apply to x-rays and other outpatient surgical procedures.
Q. WHEN AM I EXPECTED TO MAKE MY CO-PAYMENT?
A. Your co-payment is due when you check-in for your office visit.
Q. WHAT IS CO-INSURANCE?
A. Co-insurance is the amount you are required to pay for medical expenses usually after you have met your annual deductible. The amount is usually expressed as a percentage. For example if your insurance pays 80%, you pay 20%.
Q. WHAT IF MY DEDUCTIBLE HAS NOT BEEN MET AND I HAVE AN APPOINTMENT WITH YOU? WHEN DO YOU EXPECT ME TO PAY MY PORTION OF MY CHARGES?
A. If your deductible has not been met, we will expect payment at time of service. We will file your insurance if we are participating with your insurance so that they will apply your visit to your deductible.
Q. HOW WILL I KNOW IF MY INSURANCE REQUIRES A REFERRAL?
A. We have a list of all insurance companies that we participate with and, to the best of our knowledge, if a referral is required for your visit. The best way to know is to call your insurance company. You will want to make sure that your referral is in place before your visit. We will have to reschedule your visit if you require a referral and our office have not received it.
Q. I DO NOT HAVE MY INSURANCE CARD, WHAT SHOULD I DO?
A. Unfortunately, you will need to have your current insurance card with you and present it at the time of each visit with us. If, for any reason, your card is lost or stolen, please do not hesitate to call your insurance company for a duplicate card to be sent to you.
Q. DOES YOUR FACILITY PARTICIPATE WITH MY INSURANCE COMPANY?
A. We participate with Medicare and most major insurance plans. Please review our list of participating insurance companies.
Q. IF YOU DO NOT PARTICIPATE WITH MY INSURANCE COMPANY WILL YOU FILE ANY OF MY SERVICES?
A. We will file for surgical procedures done in our office or at the hospital. We will also file for x-rays done in our office. Again, if your deductible has not been met you will be responsible for payment prior to having your procedure.
Q. WILL YOU FILE FOR ELECTIVE PROCEDURES?
A. No. All elective procedures must be paid in full to the Business Office prior to having surgery scheduled.
Q. IF MY INSURANCE DENIES PAYMENT, CAN PAYMENT ARRANGEMENTS BE MADE?
A. Yes. Please contact our Business Office at 919-526-1717 and select Option 4 for further discussions regarding payment arrangements.
Referral Process
Many of the managed care health insurance plans require a referral be obtained before visiting a specialist such as an Urologist. Other insurance plans require no referrals. Each insurance plan is different. It is your responsibility to be knowledgeable about your health insurance including whether a referral is needed each time you visit our specialist.
If your insurance company requires a referral to see a specialist, then it is your responsibility to obtain referrals when:
- It is your first visit to our office
- If your insurance company has changed or if your insurance plan has changed.
- If you change your primary care doctor or have never seen your primary care doctor.
- If you have not been seen in our office in over a year.
- If you are being seen for a new diagnosis or new problem.
If you have an insurance plan that requires a referral (such as Aetna HMO or Tricare Prime), it would be beneficial to request a referral as soon as you schedule your appointment with our office. Most primary care doctors require at least 48 hours to process a referral! If you do not have a referral when you come in for your appointment, we will need to reschedule your appointment or your will be asked to sign a waiver and you must pay for your visit in full.
We have an Authorization Specialist in the Business Office that is responsible for obtaining referrals for you as an established patient and will make sure you have a referral unless denied by your primary physician.
We are happy to assist you in any way we can, but we cannot accept responsibility for knowing all of the details of your insurance coverage. Please, contact the customer relations department of your insurance company. They are much more knowledgeable and able to answer your questions better than our staff.