IN-NETWORK INSURANCES:

Blue Cross Blue Shield (BCBSNC, BCBS Federal, BCBS Out-Of-State, BCBS State Teachers Health Plan) and CIGNA (including former Great West members) are the insurance companies we presently have a contract with. Under these contracts we are obligated to collect patients’ co-payments, deductibles or any non-covered services at the time of your visit. We will file an insurance claim twice over a 30 day period. If a valid claim is filed and not paid by your insurance company due to deductibles, coinsurances, contract exclusions or any other type of denial due to your specific insurance policy, it becomes the patient's responsibility to pay the balance.

OUT-OF-NETWORK INSURANCES:

For patients with out-of-network insurance plans, we will file your claim electronically after your visit. This will save you from having to submit any paperwork on your own to file your claim. However, we do expect payment for our services at the time of your visit. Since we are out-of-network with your insurance, any reimbursement from your insurance company will be sent directly to you. You should expect to receive a statement from your insurance company approximately 4-6 weeks after your appointment. Even if your insurance does not pay for your visit, you should get a statement from your insurance company detailing the charges you incurred at our office. If you do not receive this statement, please notify our office so we verify that your claim was filed correctly.

All out of network claims at our office, when paid in full at the time of service, are filed to NOT Accept Assignment of Benefits. This should indicate to your insurance company that the payment for the service will be refunded directly to the patient. Insurance companies generally send provider EOBs within a week after the patient receives their own EOB. If our office receives a payment for out-of-network services on your behalf, you have the choice of receiving a refund check from our office or using the payment as a credit towards future visits. For refund amounts greater than $50, our office will attempt to contact you regarding the credit on your account. For amounts under $50, if you do not ask for a refund check, the payment we receive will be deducted from your next appointment's charges.

MEDICARE INSURANCE:

Family Care is designated as a non-participating provider with Medicare and Medicaid. This means Family Care does not accept assignment of benefits from Medicare or, more simply, that Medicare does not pay Family Care for any services provided. Patients with Medicare are required to pay the standard limiting charge for North Carolina Medicare providers at the time of service. This rate is determined annually by the state of North Carolina and is constant regardless of which provider you see.

After your visit, your claim will be filed to Medicare by Family Care. For almost everything, non-participating provider services will be reimbursed at 70% of your total payment and benefits will be provided directly from Medicare to the patient. If the patient has a supplemental policy, the remaining 30% will be paid by your supplemental or secondary insurance, provided the patient has notified Medicare of their supplemental coverage prior to their visit. If you have any questions regarding your Medicare coverage, benefits or our process for filing claims as a non-participating provider, please contact Ryan.

We currently do not accept new patients with Medicare, due to our non-participating status. If a current patient ages in to Medicare, they are able to continue coming to our practice as long as they abide by the non-participating rules outlined above.

CLAIM DENIALS:

It is the patient's responsibility to understand their insurance policy. If a claim is filed and we receive a denial from your insurance company, we will attempt to appeal the denial on your behalf, if possible. Certain denials require the patient to contact their insurance company to provide missing information or to verify that you have a valid insurance policy. Once we file an appeal, a denial by your insurance company becomes the patient's responsibility to contact their insurance company to rectify the denial.