Patients may request an itemized statement, pay their amount due with a checking account or credit card, set up a payment plan, and/or provide additional insurance information not given at the time of service by calling 1-866-853-9551 or through the patient portal.
What is the difference between a co-payment, co-insurance and deductible?
In most cases, health insurance carriers offer two major types of coverage: HMO plans or traditional plans. HMO plans generally set a fixed dollar amount for office visits, outpatient visits, emergency room visits and sometimes inpatient stays that the patient is required to pay directly to the provider at the time of service. This is called a co-payment.
Traditional plans and Medicare establish a fixed dollar amount that must be paid by the patient (usually annually) prior to any payment made by the health insurance carrier. This is called a deductible.
A co-insurance is typical with traditional plans and Medicare. The health insurance carrier pays a percentage of the charge and the remaining balance is the responsibility of the patient.
What information is needed to bill my insurance carrier?
The following information is required:
- The name, address and phone number of your insurance carrier.
- The subscriber’s name on the policy.
- The identification number, including any prefix and/or suffix.
- The effective date of the policy.
It is very helpful if you show the registration clerk or receptionist your health insurance identification card each time you come in for medical services. You may ask to have this information read back to you to ensure your record is accurate.
Why did it take so long for me to receive a bill?
It is a practice of General Physician, PC not to bill a patient until we have exhausted all means of obtaining payment from your health insurance carrier. At times, we receive partial payments or denials that we feel are incorrect. Therefore, we must follow the appeal process established by your health insurance carrier to dispute their decision. These processes can result in a delay in billing you for your portion of the bill.
How can I obtain a detailed or itemized statement?
Simply call Change Healthcare at 1-866-853-9551 and the representatives will be happy to mail you one.
Can I pay my co-payment or balance by credit card?
All General Physician, PC sites accept Visa, MasterCard, American Express and Discover. You may charge any payment utilizing one of these credit cards. We can also take this information over the phone, or you can pay in your patient portal.
What if I want to pay without using my insurance?
Please call your GPPC office so they can provide you with our self-pay fee schedule.
What if I am using my insurance and would like a quote regarding the amount I will have to pay after insurance pays their portion (patient responsibility)?
Please contact your health insurance company directly. They will have access to your specific insurance coverage and will be able to give you the most accurate estimate of what you will be responsible for paying.
What insurance plans does General Physician participate with?
General Physician, PC participates with several insurances, as listed below.
There are often several different plans and/or allowed services offered by an insurance carrier, and General Physician, PC may participate with only certain plans. While we have tried to list the most common plans, if you have any questions, or do not see your plan listed, please reach out to your GPPC office.
General Participation Information
|Refer to Master Grid (Z/Drive) for Provider Specific Information||GPPC Does NOT Accept - Consider Self Pay and Collect at TOS|
|Aetna Medicare||Centers Plan for Healthy Living|
|Blue Cross Medicaid - Amerigroup||Christian Care Ministry|
|Highmark BlueCross BlueShield (1)||Cost Share Plans (unless affiliated with 3rd party network)|
|EMBLEM/GHI - PPO (FEHP) and EPO lines of business ONLY (2)||EMBLEM/GHI - MCR, MCD, and Essential LOB (not available in WNY)|
|Empire Plan - NYSHIP (UHC Plan - No YLS Prefix)||Empire BCBS (YLS Prefix for in patient only)|
|Excellus BlueCross BlueShield PPO (participate via Blue Card) (3)||Fidelis Care at Home (this is a long-term home care plan)|
|Fidelis Care - (all LOB except long-term care)||First Health Plans and Network|
|HUMANA - Commercial Plans: Choice Care PPO||Kaiser Permanente Health Plan|
|HUMANA - MCR Advantage Plans: HMO, PPO, Private Fee for Service||KALOS long-term care plans|
|Humana Military||Medicaid Out of State|
|Independent Health (all LOB)||Medicaid Replacement Plans Out of Area (I.E. Excellus Medicaid)|
|Lifetime Benefit Solutions/RMSCO (self-funded via 3rd party network)||No Fault Out of State|
|MAGNACARE (Includes Aetna)||Workers Compensation Out of State|
|Martin's Point||Premier Option (Excellus)|
|Medicaid NYS||MVP (CIGNA) not par w/individual exchange or essential health plans w/MVP|
|Medicaid Pennsylvania - SELECT PROVIDERS ONLY - Per Grid||1199 SEIU|
|Medicare||Total Senior Care|
|MULTIPLAN (CIGNA) /PHCS|
|MVP (CIGNA) (NALC) Wellselect Plan|
|NYS Department of Labor|
|POMCO (self-funded via 3rd party network)|
|Tricare East (active military) Tricare for Life (retired military)|
|UPMC - SELECT PROVIDERS ONLY - Per Grid|
|VA ADMINISTRATION w/authorization only|
|Worker's Compensation NYS ONLY|
(1) General Cardiology NON PAR w/APEX Plan H4P OR D5H prefix(1) General Cardiology NON PAR w/APEX Plan H4P OR D5H prefix
(2) Only par with plans underwritten by GHI (Group Health Incorporated)
(3) Do not accept Excellus HMO plans they are limited to providers who directlyparticipaite with Excellus of which we have very few
Although General Physician, PC participates with most insurance companies, we may be excluded or limited in our participation of certain product plans offered by an insurance company. Please contact your insurance company directly to determine if your specific product plan participates with General Physician, PC.
Please note if you are having a procedure done within a hospital you should call your insurance company to ensure your plan is also PAR with the hospital or you may be responsible for payment.