Insurance Disclaimer for All Patients:
All insurance information must be disclosed at the time of service. If a patient is covered by one or more insurance plans, it is necessary to provide that information immediately. Any insurance information that is not provided to us within a timely manner that results in non-covered charges will become patient/parent responsibility to pay. For appointments on weekends your insurance will be billed with additional coding for those services. Some insurance plans apply this coding to patient responsibility. Any balance your insurance applies to patient responsibility will be billed to you. For more details, please contact your insurance company.
How AHCCCS Plans Work: AHCCCS patients must provide any other information to the office at time of service. Any insurance plan that is a commercial/private/employer sponsored or exchange plan is considered primary to your AHCCCS plan and AHCCCS requires that we bill that insurance prior to AHCCCS. If we do not bill the primary insurance first, AHCCCS will not pay the patient’s claims. Once we bill the primary insurance any amount applied to patient responsibility will be billed to your AHCCCS plan. If it is an AHCCCS covered service, they will pay the balance of the claim on your behalf.
We Currently Accept:
Self-Insured patients, Commercial/Private/Employer Sponsored Plans, Healthcare Exchange Plans and AZ AHCCCS Medicaid Plans.
(Insurances with an * could have narrow network plans that we may not be able to accept. If you have additional questions, please call the office and follow the prompts to the billing & insurances department for additional information.)
- Children’s Rehabilitative Services-CRS (Fully Integrated plan only)
- Fee for Service
- Healthnet Access
- United Healthcare Community Plan (Formerly known as APIPA)
- AZ PCP
- AETNA APCN (Aetna Premier Care Network)
- BCBS Connect Network
- BCBS Neighborhood Network
- Beech Street (Alaska, Nevada, Utah)
- Cigna Connect
- Cigna Health Plan Exclusive
- Coventry/First Health
- Health EOS through PHCS/Multiplan
- Humana Phoenix HMOx
- MIHS- Any insurance plan contracted w/ only MIHS providers
- Phoenix Choice
- QT HMO- Network: CareATC Primary Care-can only go to Banner Medical Group/Clinics
- UHC Navigate
- UHC Primary Care Plan
- University Family Care
- Value Point through PHCS/Multiplan
Explanation of Benefits (EOB) - The EOB is a statement from your insurance company that explains your benefits for a particular date of service. It includes: The services provided, by which Dr. or Facility, the amount billed, the amount your insurance allowed, the amount that insurance paid (if any) and the amount that you may be billed for (if any.)
The Birthday Rule - This is when both spouses or parents have health insurance that covers their child(ren). The birthday rule helps insurance companies coordinate benefits. Under this rule, the plan of the parent whose birthday occurs first in the calendar year is designated as primary. The date of birth is the determining factor, not the year. So it does not matter which spouse is older. It starts by month so if Dad was born in January and Mom was born in September- Dad’s insurance would be primary. In the case that both parents were born in the same month, it would then go by date. There are exceptions to the rule: If both parents share the same birthday, the parent who has been covered by his or her plan longest provides the primary coverage for the children. If one spouse is currently employed and has health insurance through a current employer, and the other spouse has coverage through a former employer (e.g., through COBRA), the plan belonging to the currently employed spouse would be primary. In the event of divorce or separation, the plan of the parent with custody generally provides primary coverage. If the custodial parent remarries, the new spouse's coverage becomes secondary. Read your policy carefully to make sure you understand how your insurance company handles dual coverage. Court orders may take precedence over the birthday rule and exceptions. Please provide the office with this documentation.