Payment Tips

Managing your health care out-of-pocket expenses

Here are some handy tips we offer in regards to billing and your health care insurance.

If you are scheduling a physical or annual exam and we will be billing your insurance, we recommend that you contact your carrier and verify coverage for a “Preventative Care” or “Well Visit”. Some insurance companies exclude preventative care. By Law, we are required to submit the bill to your insurance company coded as a well visit. If not covered, you will be responsible for the cost of your appointment. In addition, if lab tests are desired, you need to know if your carrier has an “allowed list of tests” this will help you avoid out-of-pocket expenses.

The Yearly Exam is considered a routine overview and health screening visit only, as compared to a visit that is focused on a specific health problem or concern. Insurance reimbursement for clinic visits, and allowable tests and treatments are based on a coding system and we must follow this system to optimize your coverage.

Your individual problems and concerns are very important to us and we understand that for convenience, most will want to bring up all of their concerns at the time of their yearly exam. However, we may need to schedule a separate appointment or add additional codes as we are required to bill separately under a problem-oriented focus. This is often beneficial to you in the long run, especially if any tests or follow-up care may be required as these must coincide with the appropriate coding to allow reimbursement. In some cases, individuals are being required by their insurance company to pay two different co-pays for a single visit if it appears that the visit included multiple focuses of care. If you have any questions we encourage you to contact your carrier prior to your visit and we are always happy to speak with you before your visit to clarify any questions.

Please direct questions to our Practice Manager, DJ Inouye. Please feel free to give her a call at the clinic: (425) 806-4600