Insurance

Insurance

We are contracted with all major insurance companies, however, there are many plans and networks available.  Please call your insurance company directly to confirm Dr. Arneyo Perez (aka Arneyo Perez Gil) or Kendra Carter, FNP-BC is in-network as a preferred provider.   We also provide discounts for out-of-network plans/self-pay patients, please call our office for estimated fees.

Terms to Know

Assigned PCP (Primary Care Provider): If your plan has assigned you a Primary Care Provider (PCP) that is not one of our providers, you must call and update your PCP before being seen as insurance will not back date for past visit coverage.

Annual Wellness Visit/Yearly Physical:  Most health plans will pay for one wellness or preventative exam per year. This annual exam does NOT include discussion of new problems or detailed review of chronic conditions.  The visit is to screen, counsel, and update a personalized prevention plan to help prevent illness based on your current health and risk factors.

Updated COB (Coordination of Benefits):  This is the process by which a health insurance company confirms and/or determines if they are the primary or secondary payer of medical claims.  IF an updated COB is requested, insurance will hold all claims until the patient calls and updates this information.

EOB (Explanation of Benefits):  Your health plan will send an explanation of benefits.  This will show the Billed charges to insurance, the amount that was deducted to show Allowable charges, the amount paid by your health plan, and the patient’s responsibility amount; this can include co-pay, deductible, co-insurance amounts.

Allowable vs Billed Charges:  The allowable charge is the price that your insurance company will pay a medical provider for a particular medical service.   The billed charge is higher than the allowable charge and the difference is sometimes referred to as an adjustment.

Co-Pay:   A fixed dollar or percentage amount you are required to pay for certain medical services.  This amount is due at the time of service.

Deductible:  The amount you pay for medical care before your health plan starts to contribute.  Depending on your health plan you may still have to pay a portion of expenses through co-pays and co-insurance after the deductible is met.

Co-Insurance:  Co-insurance begins after you’ve met your deductible and your plan starts to pay some of the cost.  This will be the amount you pay after your insurance has paid it’s portion of the bill.  Co-insurance is calculated as a percentage of the total cost.

Prior Authorization:  Some medical procedures and prescriptions require your insurance company’s approval before covering the cost.  Even receiving prior authorization is not always a guarantee for coverage.  Co-pays, co-insurance, and deductibles still need to be met.

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