DOES PHW PARTICIPATE WITH COMMERCIAL HEALTH CARE PLANS?
PHW is a in-network Preferred Provider Organization (PPO) with Blue Cross Blue Shield (BCBS) - participating with most PPO BCBS health plans, including Anthem, CareFirst, Federal Employee Program (FEP), etc. Specialty testing and nutraceutical supplements that may not be covered by participating health care plans.
PHW is out-of network with Aetna, Assurant, Cigna, GEHS, Humana, Medicare (opt out), Medicaid (opt out), TriCare, United Healthcare, etc. - self payment applies. Most non-participating health plans reimburse PHW patient members up to 100% for PHW's patient self payments. Contact your non-participating health plan's Member Services to learn more about your out-of-network coverage. Patients with non-participating health plans may request a medical “superbill” invoice, with ICD-10 diagnosis and CPT health care services rendered codes, per each office or virtual visit, to submit to your non-participating health insurance carrier for processing your claims for reimbursement. Please contact us before-hand to verify your health plan(s) eligibility and to discuss your estimated office or virtual visit self-pay fees. Specialty testing and nutraceutical supplements that may not be covered by non-participating health care plans.
NOTE: Some healthcare insurers cover our Telehealth virtual visits fees while others do not.
- For some participating health plans that do not cover virtual visits, prior approval may be required before patient virtual visits will be covered.
- For participating health plans, PHW will submit patient virtual visit claims to the participating health plan for payment, but any residual payment balance is the patient's financial responsibility.
- For non-participating health plans, uninsured, or self-pay patients, each office or virtual visit will require self-payment at the time of the appointment. Patients with non-participating health plans may request a medical “superbill” invoice, with ICD-10 diagnosis and CPT health care services rendered codes, per each office or virtual visit, to submit to your non-participating health insurance carrier for processing your claims for reimbursement.
DO I NEED HEALTH INSURANCE TO BE A PHW PATIENT?
Health insurance membership enrollment is not required to become a new PHW patient. PHW offers all of our patients a self-pay option to take advantage of our reasonable patient self-pay fees for the most advanced, comprehensive, and personalized health care services available - without the typical commercial healthcare plans restrictions. Please always contact us before-hand to discuss your estimated office or virtual visit self-pay fees.
HOW MUCH ARE PHW PATIENT SELF-PAY FEES?
Our reasonable patient self-pay fees are typically much less than those of premium concierge medicine practices because patient access is one of our core values. Furthermore, on a annual basis, PHW patient self-pay fees are substantially less than premium concierge medicine practices and pop-up online health care services because we never charge our patients recurring concierge practice patient membership or online subscription fees. PHW patient self-pay fees include our provider's total time for each patient appointment, including required provider preparation and review time of patient medical information, as well as any and all health care services rendered. Fortunately, most non-participating health plans reimburse their members for PHW patient self-payments. Please always contact us before-hand to discuss your estimated office or virtual visit self-pay fees.
DOES PHW ACCEPT FLEXIBLE SPENDING ACCOUNTS (FSA) OR HEALTH SPENDING ACCOUNTS (HSA) FUNDED SELF-PAYMENTS?
PHW accepts FSA or HSA account funded self-payments only if pre-approved by the patient's FSA/HSA benefits or health plan administrator. FSA and HSA funds are also typically used to pay for specialty testing and nutraceutical supplements that may not be covered by commercial health care plans.
NOTE: PHW office visits and Telehealth virtual visits fees are not inclusive of any optional health care nor any administrative services fees (e.g. third party medical records fees, patient forms, disability determinations, dietary counseling, special reports, etc.), and are solely the patient's financial responsibility since they are not covered by any healthcare plans. All patients are also 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 their specific healthcare insurance plan(s).
- Payment is due upon the time of your scheduled in-person office or virtual visit appointment.
- PHW accepts most major credit and debit cards as preferred forms of payment.
- FSA and HSA funded self payments accepted only if pre-approved by your FSA/HSA benefits or health plan administrator
- All patient billing inquiries should be directed to Physicians Billing Service.