~ Patients’ Insurance Responsibilities ~

• Know what providers are in your network.
• Obtain authorization prior to first visit if required by your insurance plan. Prior authorization is not a referral from your PCP. Contact your insurance carrier for more information.
• Provide current insurance information at time of service.

~ Exchange / Obama Care patients ~

We are OUT OF NETWORK with your plan. Because most of these plans have zero out of network benefits, you may be required to pay in full at time of service.

Examples of these plans include but are not limited to:

Aetna CVS, BCBS Home Plans, Bright, Cigna HMO Connect, Cigna NC Connect, Friday Health Plans.

 

~ NC Medicaid Patients ~

We will not file claims with Medicaid contractors that we are NOT in-network with unless you have obtained a prior authorization before your appointment. You will be billed as self-pay by our practice if you do not arrive with an approved authorization from your plan not a referral from your PCP. Please call your case worker or the number on the back of your card for help finding an in-network provider.

Out of Network:  Wellcare Medicaid, UHC Community Plan Medicaid, EBCIT, and Amerihealth Caritas.

~ Other Commercial Out of Network Plans ~

Ambetter, Aetna Duke Select, BCBS Blue Value, BCBS Duke or UNC Home, Bon Secours,

First Carolina Care, Meritain, Molina.

Audiologists and PA are also out of network also with Wellcare and PAI. Audiology and PA services will be billed to your plan and out of network benefits will apply.

~ In Network Plans ~

If you have one of the plans below please also reference above information about specific policy exclusions. Providing this list on our website in no way guarantees your plan will allow in network processing of claims as each plan could have specific limitations. This is a broad list that includes carriers we are generally contracted with. Always contact your plan for specific information relating to providers you are allowed to see and any authorization requirements.

Aetna

BCBS PPO and HMO including Medicare Advantage Plans

Carolina Complete Health NC Medicaid (Dr. McElveen and Dr. Richards only)

Cigna

Healthy Blue NC Medicaid (Dr. McElveen and Dr. Richards only)

Humana Choice and Medicare Advantage Plans

Medcost

Medicare

NC Medicaid

PAI (Dr. McElveen only)

Tricare

UHC Commercial and Medicare Advantage

UHC Community Plan Medicare only not Medicaid

Wellcare of NC Non-Medicaid (Dr. McElveen only)