Participating Insurance Companies
To meet needs of the community, we continue to update our network participations. Please continue to check this page for latest update.
Apex MD is currently in network with the following insurances:
- Anthem/BlueCross BlueShield/Wellpoint
- Coventry/Southern Health
- Great West Healthcare
- Health Net Federal/Tricare
- Virginia Health Network
Please note with HMO plans that require a PCP selection, Dr Rumki Banerjee should be listed as PCP. Alternatively Apex MD must receive prior authorizations/referral from your other Primary Care Provider (PCP) prior to being seen.
Insurance though, is not required to be seen in our office. Apex MD provides a prompt-pay discount to Self-Pay patients.
Getting to Know Your Insurance Benefits
Knowing and understanding your insurance benefits takes much of the surprise out of healthcare.
Each insurance plan offers something different, even within one insurance carrier. Even with a “good” health-insurance policy, not every service may be covered in full, and the patient is ultimately left with the responsibility to pay the amount not covered.
This is just a brief explanation of the types of financial responsibility incurred in a physician’s office. It is important that you understand your benefits.
We strive to give you the most complete and accurate insurance and billing information available to aid in your decision. However, it is your responsibility to contact your insurance company for a complete explanation of benefits.
Some insurance policies require that a deductible be met before coverage begins. For example, if you have a $2,000 deductible, you must pay that amount before expenses are covered by the insurance company. Your insurance company can tell you how much of your deductible has been met to date.
Other insurance plans have a coinsurance requirement, which means the patient and the insurance company each pay a specific percentage of the day’s visit. Your insurance company can provide information about the allowable amounts.
Some plans require that the patient pay a set amount for each visit. This may or may not include any tests or procedures associated with the visit.
Some plans require co-pay for the office visit, and then have a deductible for labs and/or procedures.
Some insurance policies may also have combination of deductibles, coinsurance, and co-pays. For example, a policy may require a subscriber to meet $1,500 deductible, after which the subscriber is required to pay 10% coinsurance.
Do I have to pay at the time of visit?
In almost all cases, some payment is required at the time of visit, whether it is a deductible, a co-pay, or payment for any non-covered services.
We are required by our insurance contracts to collect all co-pays and other patient responsible amounts, at the time of service.
If you have not met your deductible – we will estimate the expected insurance payment for your visit and request that amount at check-out. This is an estimate only – you may receive a statement with additional balances after your visit. Charges are finalized after medical claim has been processed by your insurance company.
You will be expected to pay in full if:
- You do not have insurance
- We do not participate with your health plan
- You have an HMO Plan where we are not listed as your Primary Care Provider (PCP)
- You are unable to present a valid member identification card from your insurance carrier at your visit
- We are unable to verify your insurance coverage at the time of service
For additional details please refer to our Patient Financial Policy, available at our Front Desk and also under forms section on the web.
Insurance Coverage of Travel Vaccination
Travel Vaccination is normally not covered by insurance plan benefits
Insurance Coverage of Physical Exams
School, Sports, Camp, Work, Scout, and College Physical Exams are not normally covered by insurance plans.
Insurance plans typically cover one regular physical exam per year. Some plans waive patient responsibility for annual physical exam, while others expect member to pay applicable deductible, co-pay, or coinsurance for the visit.
Services that are not normally covered by insurance plans during a physical exams:
- Evaluation and Management of specific acute problems or illness. Example would be discussion of a recent cough and sore throat, pain or injury.
- Procedures other than a pap smear. Example would be mole removal, skin biopsies
May I Request a Change in the Way My Services were Billed to My Insurance Company?
It is very important to understand your insurance coverage so you will not be surprised if a specific type of service is not covered by your policy. Billing must reflect what happened during your medical visit and match what is recorded in your medical record. Appropriate billing is a federal legal requirement and it is considered fraudulent to change billing information solely to obtain reimbursement.
Explanation of Additional Fees for Extended Hours Service
In order to help compensate for our higher operating costs during evenings (after 6 PM), weekends, and holidays, Apex MD uses Extended Hours Service specialty code while submitting insurance claim on your behalf. The fee for this service code is up to $50. This fee is added to the baseline charges for your visit. Most insurance companies recognize this billable charge and will provide full or partial reimbursement. You may be responsible for only the allowable portion of this charge in the event that your insurance company assigns it to your deductible or coinsurance. If the service is not allowed by your insurance plan the entire fee will be adjusted and not billed to the patient.