“Is my Insurance Provider In-Network with Modern Women’s Health?”

We maintain in-network status with a wide range of commercial insurance plans, ensuring seamless access to our services for covered individuals. However, it’s important to note that we are classified as out-of-network providers for all exchange, HMO, and Medicare/Medicaid/TRICARE plans.

PPO: Type of health insurance plan known for its flexibility. Coverage is provided to participants through a network of selected health care providers, such as hospitals and physicians. Plans allow you to get medical care from a provider outside the network, but services are covered at a smaller percentage.

HMO: A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency.

EPO: This plan provides members with the opportunity to choose in-network providers within a broader network and to visit specialists without a referral from their primary care doctor. EPO plans offer a larger network than an HMO plan but typically do not have the out-of-network benefits of PPO plans.

Government Funded Plans: Medicare, Medicaid, Marketplace/Exchange, TRICARE (all other armed forces plans), etc…

“How much will my visit cost?”

We believe in transparency and want to ensure that you are well-informed about any potential financial responsibilities prior to your visit. As part of this commitment, we include a detailed estimate of anticipated costs in your appointment confirmation email.

Upon receiving your insurance details, our team will conduct verification of your coverage. Please be aware that while we strive to provide comprehensive information in your appointment confirmation email, there may be instances where certain add-ons or specific insurance verification details are not readily accessible or included in the estimate.

“What If I am out-of-network or don’t have insurance?”

In addition to insurance coverage, we understand the value of offering flexible payment options. As part of our commitment to your convenience, we provide private pay discounts. This means that if you choose to pay for our services directly without utilizing insurance, you may be eligible for reduced fees for payments made in full at the time of your visit.

Your benefits constitute a contractual agreement between you and your insurance provider. For detailed information regarding your specific coverage and network status, kindly contact the number provided on the back of your insurance card. In the event we are not in-network with your insurance, it is important to note that you will be responsible for the disparity between physician charges and any out-of-network payments that may arise.

“What If I schedule an appointment/provide new insurance information on the same day that I am seen?”

Some cases may experience delays in our standard verification and estimation process. As our small team submits your insurance details and reviews your benefits extensively to provide this estimate. A few applicable cases are listed below:

  1. Appointments scheduled on the day of service
  2. Updated or new insurance information provided at the time of your appointment.
  3. Delays in insurance correspondence, including pending eligibility requests, inaccuracies in patient information, and other common errors such as typos.

We appreciate your understanding as we work diligently to provide you with the most precise and comprehensive information.

“What If I provide outdated/inaccurate Insurance Information?”

We have an obligation to file our practice’s claims in a timely manner. Incorrect credentials and demographics will most likely result in a denial of your claim from your insurance. In the event your claim is denied due to inaccurate information, despite documented efforts on our part to obtain correct details, any resulting balance will be reflected in your account.

To support accuracy, we are dedicated to offering opportunities and reminders for you to update your information before or at the time of your appointment. This proactive approach is aimed at minimizing the risk of claim denials and ensuring a smooth reimbursement process. Your cooperation in maintaining up-to-date and precise information is essential to facilitate seamless transactions with your insurance, and we appreciate your attention to this matter.

“What if my Physician advises a procedure or service be added onto my visit?”

Add-ons, including additional services or procedures, may be subject to separate charges not reflected in the initial estimate. This estimate is based on the information available at the time of scheduling and the results of our insurance coverage verification process. It serves as a valuable reference, providing clarity on potential out-of-pocket expenses associated with your visit. See our FAQs/ Preventative vs. New Problems sections for specific examples of add-ons.

Commitment to Care

Our goal is to accommodate our patients’ financial situations and make our services accessible to those in need. Please feel free to reach out if you have any questions or concerns regarding your insurance coverage, verification process, or payment options. We are here to assist you in navigating these aspects of your healthcare experience.

Practice Manager, Kelly Zimbelman – kzimbelman@lisamjukesmd.com

Financial Coordinator, Samantha Kins – skins@lisammukesmd.com