Insurance Information

Policy Regarding Referrals / High-Deductible Insurance Plans

HMO Plans and Patients Requiring Primary Doctor Referrals (All HMO Insurance Plans)

New patients and returning patients who need an insurance referral MUST arrive for their appointment with a referral. Per medical insurance regulations, without a referral the patient CANNOT be seen, and the appointment must be rescheduled.

(Please feel free to contact the office prior to your appointment to confirm that we have received the referral from your primary medical doctor.)

Patients with High-Deductible Insurance Plans

• New Patients – We collect $175 towards your deductible when checking in for your appointment.  You will receive a statement for any additional member responsibility due after your insurance company has processed your claim.
• Established Patients – We collect $50 towards your deductible when checking in for your appointment.  You will receive a statement for any additional member responsibility due after your insurance company has processed your claim.
• If we have verification that your deductible has been met, nothing will be collected at the time of your appointment.  You will receive a statement for any member responsibility due after your insurance company has processed your claim.

Medications Not Covered By Your Insurance / Not on Your Medication Formulary

Medical insurance companies frequently change the medications on their formularies that are covered/paid for by the insurance company. If a medication is not on the formulary, you are responsible for paying a higher co-pay, or for the full cost of the medication. Your insurance will not cover non-formulary medications unless the medications that are covered under your plan are tried and failed.

If a medication that you require is not covered by your insurance, a Medication Prior Authorization Form needs to be submitted to your insurance company. In order to help us expedite this process, please call our office.

Submitting a prior authorization request does not guarantee coverage of the medication.