Insurance questions

Frequently Asked Questions About Insurance

(757) 668-8931
The following is a list of frequently asked questions related to insurance. Do not hesitate to contact one of our patient account technicians if confused about any part of your bill or your insurance.

How do I know if you participate with my insurance?

Review your plan directory or contact your insurance to make sure our physician(s) participates with your insurance.

Will you bill my insurance?

As long as our facility participates with your insurance company, we will file the claim as a courtesy to you. If we are not participating, we will provide you with a receipt for services for you to file your individual claim, if necessary.

What is the difference between an HMO and a PPO?

An HMO is a legal corporation that provides healthcare in return for pre-set monthly payments. For most HMOs, members must use the physicians, hospitals and other healthcare professionals in the HMO's network in order to be covered for their care. 

A PPO is a network of contracted doctors and hospitals that provide health care services at a pre-negotiated lower price. Members receive better benefits when they use network providers, but have the option to used out-of-network providers for higher out-of-pocket costs.

What is the difference between "in-network" and "out-of-network" providers?

Healthcare providers and facilities contracted to provide services with your health plan are called "in-network" providers. You will greatly reduce the cost of your medical care by getting all services from your "in-network" providers. Your health plan should provide you with a list of these. All other providers are considered "out-of-network." Receiving care from these providers and facilities will increase your out-of-pocket costs.

How do I know if a referral or pre-authorization is necessary?

Review your benefits booklet or plan reference material for guidance. Otherwise, contact your insurance plan at the number listed on your insurance card. 

I don't have insurance, what are my options?

Cover Virginia educates parents and patients about Virginia’s Medicaid and FAMIS programs for children, pregnant women and adults. You can also get information about health insurance options available through the Federal Marketplace and can apply online or search for someone who can assist you with your application.

    What if my child does not currently have health insurance?

    Please contact one of our health benefit analysts to evaluate your child's eligibility for health insurance programs. Our analysts office is located near the front entrance of the hospital and the office hours are Monday through Friday from 7 a.m. to 9 p.m. You may also call them Monday through Friday, 8 a.m. to 5 p.m., at (757) 668-7202, and 5 p.m. to 9 p.m. at (757) 668-7682.

    I belong to an HMO and my child went to the emergency room for care, what should I do?

    An HMO has strict guidelines for seeking service outside your Primary Care Physician. Customarily, referrals and/or authorizations are required in order to pay the claim or you may be personally responsible. Make sure you coordinate the issue through your PCP within 24 hours of your visit.

    (757) 668-8931

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