Billing & Insurance
We participate with many different insurance plans and will file for reimbursement. It is your responsibility to know the details of your health insurance plan with regard to referrals, co-payments and percentage of coverage. See which plans we participate in.
Billing & Insurance
We participate with many different insurance plans and will file for reimbursement. It is your responsibility to know the details of your health insurance plan with regard to referrals, co-payments and percentage of coverage. See which plans we participate in.
Managed Care
If you are insured by a managed care plan, our office will verify benefits and file your claims. Your most current insurance card must be presented at each visit. If you have not satisfied your deductible, or if a co-pay or co-insurance is part of your insurance contract, you will be asked to pay this at the time of your visit.
Insurance Plan Participation
Our goal is to participate in as many of the most popular and common managed care and insurance plans in the Piedmont Healthcare Network. Therefore, the list of plans we participate in is regularly undergoing review and changes.
- Blue Cross Blue Shield
- Aetna
- Cigna
- Care Credit
- Blue Cross Medicare Advantage
- Aetna Medicare PPO
- Cigna HealthSpring Medicare Advantage
- PHCS
You should always contact your insurance plan before scheduling an appointment to confirm that we are in your network.
Understanding Insurance Terms
| TERM | WHAT IT MEANS |
|---|---|
| Premium | The monthly amount you pay to keep your insurance active — regardless of whether you use any healthcare services that month. Heads up A lower premium often means a higher deductible. Make sure you know both numbers on your plan. |
| Deductible | The total amount you must pay for covered services before your insurance begins paying — preventive care is usually covered right away. Heads up This amount resets every January 1. If you have upcoming procedures, timing matters. |
| Copayment (copay) | A fixed, flat fee you pay for certain services — usually collected at the time of your visit. Example Your plan might charge $30 for a specialist visit, regardless of what the visit costs overall. |
| Coinsurance | Your share of the cost for a covered service, expressed as a percentage. This kicks in after you’ve met your deductible. Example With 20% coinsurance on a $500 service, you’d owe $100 and insurance covers the remaining $400. |
| Out-of-pocket maximum | The most you’ll ever pay for covered services in a plan year. Once you hit this limit, insurance pays 100% for the rest of the year. Heads up This is your safety net for high-cost years. Check this number on your plan — it varies widely. |
| In-network | Providers and facilities that have a contracted agreement with your insurance plan, meaning they’ve agreed on set rates. You pay less when you stay in-network. Heads up Always confirm a provider is in-network before your visit — your insurer’s online directory may not always be current. |
| Out-of-network | Providers who do not have a contract with your insurance plan. You can still be seen, but your costs will typically be significantly higher — and some plans don’t cover it at all. Heads up Some plans (like HMOs) may not cover out-of-network care except in emergencies. |
| Prior authorization | Approval your insurance company requires before they’ll cover certain services, procedures, or medications. Your provider typically submits this on your behalf. Important If a prior authorization is required and not obtained, your claim may be denied even if the service is medically necessary. Ask our office if your procedure requires one. |
| EOB (explanation of benefits) | A summary document your insurance sends after a claim is processed. It shows what was billed, what insurance paid, and what — if anything — you may owe. Heads up An EOB is not a bill. Wait to receive an actual bill from your provider before making a payment. |