Insurances and Fees
Fees are payable at the time of your office visit unless other arrangements are made in advance of your examination. All co-pays, deductibles, and/or co-insurances are collected at the time of service. We accept all major credit cards and personal checks for office visits. Please be advised that all appointments not canceled within a 24-hour notice are subject to a $50 fee. There is also a $200 cancellation fee for scheduled surgeries that are canceled less than five business days from the date and time of surgery unless cancellation is due to insurance denial or medical necessity.
Administrative Services Fees
There is a fee for patient Administrative Services. Our office collects an OPTIONAL Administrative Service Fee of $15 annually for Gynecologic visits and $75 per pregnancy for Obstetrical visits (payable at the beginning of the Prenatal Care), which covers all forms needed during your pregnancy. YOU ARE NOT REQUIRED TO PAY THIS FEE; however, if you choose not to pay the fee, there is a $20 charge for each required completed form, payable prior to service completion. Should forms need completion on behalf of a spouse or parent, this fee will be billed under the patient account.
- Aetna Georgia Community Network
- Aetna South GA Select
- Aetna Wellstar
- Aetna Whole Health: Emory Healthcare Network & Northside Hospital
- Ambetter Wellstar Select
- BCBS Pathway
- Alliant PPO-SoloCare
- Liberty Healthshare
- UHC “Deere Premier” Network
- UHC Core (eff 1/1/2022)
- UHC Charter (eff 1/1/2022)
- Wellcare Medicare Advantage
- Anthem BCBS Blue High-Performance Network
- Multiplan (by itself)
- Friday Health Plan
- MediShare PHCS
HMO and PPO plans generally have provider books or lists that show you which doctors are in network for your plan (meaning which doctors have contracts with your insurance plan). By choosing a provider from your insurance list, you will obtain the highest benefit your policy offers. If you choose to see an out-of-network physician (one that does not appear on their list), generally, the benefit is less (maybe none), meaning higher patient financial responsibility. Every insurance is different, so we encourage you to check your insurance before your appointment.
Only your insurance company can answer that. We make every effort to verify your benefits prior to your visit and ask that you do the same so that you are informed of your coverage.
A Surgery Deposit is the amount estimated to be ‘your portion’ of an upcoming surgical procedure. It is paid prior to surgery and held until your surgery claim has been paid. The deposit is then applied to the remaining balance (according to your insurance company), then you will either be refunded or billed the difference.
A deductible is a predetermined amount of money (by the insurance company) that a patient pays out of pocket before the insurance company is responsible for any benefit payment.
Co-insurance is when the insured shares the cost of a medical claim up to a certain amount. For example, many companies offer plans that pay claims at 80%. This means that the patient would pay 20% of the claim.
Generally, this is a set amount of money (by the insurance) that an insured patient pays at each visit.
Most doctors are accepting Medicare for new and existing patients.
Unfortunately, PWH does not accept Medicaid.
A contracted fee is a term used by an insurance company to refer to a dollar amount that a physician can collect for a specific service. This amount has been agreed upon by the insurance company and the physician. For example, PWH may bill $50 for a particular procedure, but for XYZ insurance company, the contracted fee is $40. This means that $10 is ‘not allowed’ and therefore not collectible; the maximum amount we can collect is $40.
PWH will file your claim if we are ‘on the insurance plan.’ Meaning we are ‘in-network’ or ‘contracted’ with the insurance company.
We do not file secondary insurance.
Understanding Maternity Benefits
Global fee is a term used to describe how most insurance companies require that we bill for your maternity care. This global fee includes all of your routine prenatal visits, the delivery, and a postpartum follow-up visit. Lab work, ultrasounds, hospital visits, all hospital charges, circumcision, etc., are not part of the global fee and are billed separately.
An OB Deposit is the amount estimated to be ‘your portion’ of your maternity care with our office. It is paid at the 16th week of your pregnancy and held as a deposit until the delivery and any other claims are paid. At that time, the deposit is applied to your remaining balance (according to your insurance company), then you will either be refunded or billed the difference. Our financial coordinator will meet with you at your pregnancy confirmation appointment to review your benefits and OB deposit with you.
The co-pay applies to the confirmation of pregnancy and your new OB visit. Your insurance company may charge you an additional co-pay for any non-routine visit or ultrasound.
Each time you have a prenatal visit, we are rendering a part of the global service. The money you are paying is for services over your entire pregnancy.
We won’t bill your insurance until you deliver, so no claim has been sent. We will reflect your prepayment when we submit the claim.
Piedmont Atlanta Hospital is estimating your financial responsibility based on the deductible met to date. Tell them you have prepaid us the deductible and ask them for a new estimate. The deductible will be applied to the first claim submitted, and we always bill first.
The year of the delivery.
Since we bill globally, all prenatal visits covered under the old plan will be billed to the old insurance. We will re-verify your benefits with the new insurance and adjust the prepayment.
HSA may be used for prepayment as long as there are funds available. Unfortunately, Flex spending accounts may only be used after a claim has been filed and cannot be used for prepayment. If you have a Flex account, we will collect the prepayment utilizing another form of payment. After processing the delivery claim, you can call the central billing office to bill the Flex account and refund the prepayment.