Insurance

We are pleased to participate in most managed care plans, such as HMOs, PPOs, etc., that are available in this area. Please identify your type of insurance when calling for an appointment. Please note that we do not participate with any Medicaid plans.

You are responsible for contacting your insurance company prior to any visits to ensure insurance coverage, verify benefits, co-payments, and deductible amounts for the services received in our office. If pre-authorization is required for services you receive, you must let us know well in advance, so we can assist you in obtaining approval.

Insurance companies may reimburse for fees covering the majority of the services you receive from us, depending on your criteria. However, there may be some services which are either not covered or limited in coverage. You should be thoroughly familiar with the coverage provided by your particular insurance plan.

As a courtesy, our office staff will file your in-network insurance at no charge for obstetrical and surgical care and for regular office visits and check-ups. In order to provide this service, we need your insurance information plus a signed authorization. It is important to note that you are ultimately responsible for payment of your account. Insurance is considered a method of reimbursing you for fees paid to the physician. It is not a substitute for payment. 

  • Aetna and Aetna Medicare
  • Blue Cross Blue Shield (we are not in network with the Atrium and Blue Local Plan). Our local hospitals do not participate with UNC Blue Local, so you would need to see a UNC physician for in-network benefits.
  • Blue Medicare 
  • Cigna
  • First Health
  • MedCost
  • Medicare
  • PrivateHealthCareSystem/Multiplan
  • Humana Medicare
  • Health Team Advantage
  • TriCare Standard & Reserve Select (not Prime and Remote)
  • UnitedHealthCare and UnitedHealthCare Medicare Advantage Plans  
  • UMR

This list may not be complete or updated at the time of your visit. Please make sure to call our office if your insurance coverage changes. This information can change without notice. 

  • Quick Answers Icon Questions & Answers

Routine annual exam visits for patients are scheduled to promote wellness and disease prevention. These visits can also include additional services, such as vaccinations, screening labs, counseling, and even management of insignificant medical problems. Unfortunately, many patients think this visit also includes management of all problems they want their provider to address during this visit.

 

Significant problems (e.g. irregular bleeding, abdominal pain, etc.) require additional work-up and the visit now becomes a combination preventive and problem-oriented visit. The problem-oriented visit is not a component of the annual exam and the provider, if time allows, will do both but will also have to bill an additional code to your insurance company. The additional code will most likely be subject to a co-pay, co-insurance, or deductible. Always let staff know ahead of time if you have a problem you need addressed during your visit. Depending on the type and complexity of the presenting problem, your provider may ask you to come back for either the preventive visit or the problem-oriented visit if there is not enough time to address both.

 

Please also note that if you also see your primary care for part of your wellness exam and schedule your breast and pelvic exam with us, we may be billing the same code. Your insurance company will only pay for one annual exam, and you will be responsible for the full billed amount of the denied service. Always check with your primary care provider to see how they have billed your exam and let us know as well so we can possibly prevent additional out of pocket expense for you.