Do you participate with healthcare insurance plans? How much will my office visit(s) cost if you do not participate with my health plan?
Potomac Health & Wellness only participates with select Blue Cross Blue Shield (BCBS) PPO health care plans and we are also a certified, non-assigned TriCare North non-network provider. For patients with our select participating BCBS PPO health plans, and who have met their current calendar year deductible, our office will submit your office visit claims, on your behalf, to your specific participating BCBS PPO health plan. However, you are solely financially responsible for all of your assigned co-pays, co-insurances, deductibles, account balances, etc., due at the time of your appointment. For patients with our select participating BCBS PPO health plans, and who have not yet met their current calendar year deductible, you must self pay for your office visits until your deductible has been met. For patients with TriCare North, you must self pay for your office visits and submit your office visit claims documentation, that we do provide, to TriCare North for reimbursement.
Unlike Inova, Potomac Health & Wellness does not participate with Aetna, Assurant, BCBS (non-PPO), Cigna, Humana, United Healthcare, etc., all considered non-participating health plans. Similarly, Potomac Health & Wellness does not participate with health maintenance organization (HMO), point of service (POS), exclusive provider organization (EPO), Medicare, Medicaid, etc. health care plans, all also considered non-participating health care insurance plans. For non-participating health plans or uninsured patients, we provide you simplified, affordable office consultation fees for self payment. We provide all necessary office visit claims documentation to submit to your specific health plan for reimbursement. Payment is due upon the time of your scheduled appointment. We accept most major credit cards as forms of payment.
NOTE: Office consultation fees are not inclusive of any additional health care or administrative services (e.g. medical records or medical documentation review, medical record fees, third party patient forms, disability determinations, dietary counseling, special reports, etc.), which are an additional charge, ranging anywhere from $25-$100, due at the time of your scheduled appointment. All patients are solely financially responsible for all of their third party, health coordination services, including labs, pharmacies, imaging, etc. which may or may not be covered by your specific healthcare insurance plan.
My health plan indicates that your provider participates with it, so why does Potomac Health & Wellness not participate with it too?
Our provider is affiliated with both Potomac Health & Wellness and the Inova Health System. As such, our provider has two distinct and separate provider profiles with regards to participation with healthcare insurance plans:
- Potomac Health & Wellness only accepts select BCBS PPO health care plans; therefore our provider participates with only those select BCBS PPO health care plans for all patients seen at Potomac Health & Wellness.
- Inova has a wide network of participating health care plans; therefore our provider, participates with Inova's large network of accepted health care plans for all patients seen only at Inova's medical facilities.
Unfortunately, this arrangement unnecessarily confuses many new patients, because most healthcare plans fail to make this organization-specific distinction to their members, and Inova also uses our provider's individual National Provider Identifier (NPI) number to bill all of their health plans. Therefore, to avoid receiving any inaccurate provider participation information from your specific healthcare plan, please reference Potomac Health & Wellness' organization NPI number, and not our provider's individual NPI number, because most health plans will confuse our provider's dual health plan participation profile and erroneously indicate that our provider participates with a Inova accepted health plan, which is not accepted at Potomac Health & Wellness. You may also contact Physicians Billing Service to further clarify your specific health plan's participation status with Potomac Health & Wellness.