Frequently Asked Questions about Insurance
Click on the question to view the answer.
- How do I know if you participate with my insurance?
Answer:
Review your plan directory or contact your insurance to make sure our physician(s) participates with your insurance.
- Will you bill my insurance?
Answer:
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?
Answer:
An HMO is a legal corporation that provides health care in return for pre-set monthly payments. For most HMOs, members must use the physicians, hospitals and other health care 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 from "in-network" and "out of network" providers ?
Answer:
Health care 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?
Answer:
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?
Answer:
There are several organizations able to provide assistance based on financial status. Locally, the Center for Pediatric Research (CPR) works in conjunction with FAMIS to provide such a service.
A FAMIS application is available below for your convenience. Print and complete section 7 of the application and submit it to the CPR. You may also drop it off at any of our CMG practice locations. A FAMIS representative will then contact you to answer questions and complete the application process.
- I belong to an HMO and my child went to the emergency room for care, what should I do?
Answer:
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.