Working with insurance can be complicated. Here, we'll summarize the process and provide a list of Frequently Asked Questions (FAQ's) and Answers.
Claim Processing
- Provide your paperwork and copies of your insurance cards.
- Have your appointment.
- We send a claim to your insurance.
- The insurance responds. They may adjust the price of the visit and make a payment. If you have a secondary or supplemental insurance, this process is repeated by that policy.
- After the claim is processed by your insurance(s), we send a statement to you for the remaining amount. You may have a balance if you've not yet met your deductible or out-of-pocket for the year or if the insurance chooses to not cover the full price of the claim.
We hope this list of FAQ's helps!
Q: Are you in-network with my insurance?
A: Probably! We are contracted with most plans. Here are the most common:
- Aetna PPO
- Aetna MA
- Ambetter
- Amerigroup Star/Star+
- BCBS
- Cigna
- Galaxy PPO
- Health Care Highways
- Health Smart
- Humana
- Medicare
- Molina CHIP/Perinate
- Multiplan PPO
- PNOA
- Superior
- TriWest
- UHC / UHC Star+
- USAA
- WebTPA
It is the patient's responsibility to ensure the provider is in-network. We recommend you call your insurance to verify. If we are not in-network, your insurance may allow you to receive out-of-network benefits. Call your insurance to verify. Even if your insurance will not cover your visit, we're still happy to see you on a self-pay basis!
Q: How do I pay my bill?
A: We accept cash, card, check and money order. You may:
- Pay online through our payment portal with a debit/credit card
- Call us on the phone and provide us with your debit/credit card information
- Visit us in the office to pay with cash, card, check or money order
- Mail a check, cash or money order
Q: Do you bill through Peterson?
A: We only bill for Dr. Ducker's services. You may receive bills from the facility, anesthesiology, pathology, etc. because they are all different companies.
Q: Do I get a Peterson discount?
A: Unfortunately not. Since we are a separate company we have different billing policies.
Q: How much will I owe after my procedure?
A: All claim processing is done after the service has been provided. For out-of-pocket information, you'll need to contact your insurance.
Q: What is a copay?
A: Your copay is the down payment you make for a service. The amount is usually listed on your insurance card. We require your copay at the time of your office visit if your insurance card indicates you have a copay for specialists.
Q: What is a deductible?
A: Insurance policies will often have a deductible, an amount required by the patient before insurance will pay for services. Everyone's policy is different so contact your insurance for details on your specific plan.
Q: What is an out-of-pocket maximum?
A: This is the highest amount your insurance will require you to pay for covered services. Once you've met your deductible, you may still be billed for services. The amount you pay is called coinsurance and it goes toward helping you meet your out-of-pocket.
Q: Do I need a referral?
A: Referrals from a primary care physician are always helpful; however, they are only required if your insurance policy indicates it's needed. Look for these key words on your insurance card to see if you need a referral before seeing us: HMO, HME, Health Select, Referral Required.
Q: How do I obtain a referral?
A: Call your primary care physician and tell them you have an insurance that requires a referral for you to see a specialist. They'll send us a referral and insurance authorization.
Q: Self-Pay information
A: If you do not have insurance, you may be eligible for a discount if you pay in full at the time of service or upon receipt of your first statement. Christian Ministries and Health Share plans are not eligible for self-pay discounts as the payer is fully reimbursed by the policy.
Q: Do you allow payment plans?
A: We will be happy to set up a payment plan for you! Please call the office to discuss and customize.
Q: Do you have a collections agency?
A: We will attempt to contact you for payment several times before sending the account to collections. Our collections agency is Transworld Systems Inc. If your account has to be transferred to collections, you will incur a $15 fine.