The Most Frequently Asked Questions about Insurance
At Fifth Avenue, we understand the burden of healthcare costs. We make it simple for you by calculating your financial responsibility upfront. We provide a clear number that you will be responsible for each visit. We break up the costs described below, so it’s not all at once.
1. In or Out of Network? (What’s with all the confusion?)
- When a doctor’s office is in-network with an insurance company, it means they agree to accept terms and rules dictated by the insurance company rather than federal standards. This allows the insurance company to minimize contribution to your care and limit resources.
- When you choose to go out of network, the insurance company must reimburse at a market rate, allowing for increased resources and better overall treatment.
2. Why am I paying more than just my Co-Pay?
- Many people forget that they have a deductible and co-insurance. Currently, both are very high and growing. Whether you choose to go in or out of network you are responsible for additional cost such as your deductible, co-insurance or out of pocket maximum.
3. What is a deductible?
- The deductible is the amount of money you are required to pay before the insurance company starts to pay. This amount is subtracted from their initial reimbursements.
4. What is Co-Insurance?
- Co-insurance is the percentage the insurance company expects you to pay additionally towards your care.
5. How many visits do I have?
- All insurance plans are a little different. Most likely you will have a set amount per year, ranging from just a few to unlimited. Ask the front desk if you are ever unsure how many you have left!
6. If I choose out of network, do I need to take any additional steps?
- Some insurance plans will mail payments to you rather than Bodhizone. They will alert us that a payment was made and for how much. Just bring in those checks as they come.
7. How come Zoc Doc says you are In network with my Insurance Company and now you say you are Out?
- We are In network with your insurance company but for the reasons listed above, we prefer Out of Network for your care.