FAQs: Insurance Related
What insurance plans do you accept?
We accept most HMO and PPO plans. Visit our ‘Accepted Insurance Plans’ page or call our business office at 339-6626.
What does ‘in-network’ or ‘out-of-network’ mean
HMO and PPO plans generally have provider books or lists that show you which doctors are in network for your plan (meaning which doctors have contracts with your insurance plan). By choosing a provider from your insurance list, you will obtain the highest benefit your policy offers. If you choose to see an out-of-network physician (one that does not appear on their list), generally the benefit is less (maybe none), meaning higher patient financial responsibility. Every insurance is different, so we encourage you to check your insurance before your appointment.
Will my insurance pay for my visit?
Only your insurance company can answer that. We make every effort to verify your benefits prior to your visit and ask that you do the same so that you are informed of your coverage.
What questions should I ask my insurance company when verifying my benefits for my appointment?
Please download the form (either gyn or ob) and follow the questions as listed. Please bring that completed form to your appointment. This will be very very helpful to both of us.
What is a ‘global fee’?
Global fee is a term used to describe how most insurance companies require that we bill for your maternity care. This global fee includes all of your routine prenatal visits, the delivery and a post-partum follow up visit. Lab work, ultrasounds, hospital visits, all hospital charges, circumcision, etc. are not part of the global fee and are billed separately.
What is an ‘ob deposit’ or ‘surgery deposit’?
An OB Deposit is the amount estimated to be ‘your portion’ of your maternity care with our office. It is paid at the beginning of the pregnancy and held as a deposit until the delivery and any other claims are paid. At that time, the deposit is applied to your remaining balance (according to your insurance company), then you will either be refunded or billed the difference. A Surgery Deposit is the amount estimated to be ‘your portion’ of an upcoming surgical procedure. It is paid prior to surgery and held until your surgery claim has been paid. The deposit is then applied to the remaining balance (according to your insurance company), then you will either be refunded or billed the difference.
What is a Deductible?
A deductible is a predetermined amount of money (by the insurance company) that a patient pays out of pocket before the insurance company is responsible for any benefit payments.
What is Co-insurance?
Co-insurance is when the insured shares the cost of a medical claim up to a certain amount. For example, many companies offer plans that pay claims at 80%. This means that the patient would pay 20% of the claim.
What is a ‘Co-pay’?
Generally, this is a set amount of money (by the insurance) that an insured patient pays at each visit.
Does RWG accept Medicaid?
Yes, but for pregnant patients only. We accept Superior Star Medicaid. We do not see gyn patients with Medicaid insurance.
Does RWG accept Medicare?
We accept Medicare on established patients only. Unfortunately, we are not accepting New Medicare patients at this time.
What is a ‘contracted fee’?
A contracted fee is a term used by an insurance company to refer to a dollar amount that a physician can collect for a specific service. This amount has been agreed upon by the insurance company and the physician. For example, RWG may bill $50.00 for a particular procedure, but for XYZ insurance company the contracted fee is $40.00. This means that $10.00 is ‘not allowed’ and therefore not collectible; the maximum amount we can collect is $40.00.
Will RWG file my insurance claim for me?
RWG will file your claim if we are ‘on the insurance plan.’ Meaning we are ‘in-network’ or ‘contracted’ with the insurance company.
Will RWG file my secondary insurance?
Yes, as long as we are contracted (in-network) with your secondary carrier.