Billing & Insurance
We participate with most local and many national insurance plans. However, it is your responsibility to understand whether your insurance has limits on the doctors you can see, or the services you can receive.
If you provide complete and accurate information about your insurance, we will submit claims to your insurance carrier and receive payments for services. Depending on your insurance coverage, you may be responsible for co-payments, co-insurance, or other deductible amounts.
Please contact our billing office or call your insurance carrier should you have questions.
Please be aware that some services may not be covered by insurance. Please call us at 706-278-4640 with any questions.
What’s covered by my insurance?
With the constant changes in the healthcare industry we encourage all of our patients to call their insurance to be familiar with the coverage of their plan.
Some of the most common services we provide are:
Routine Gynecologic Visits
Bone Density Tests
Do you take my insurance?
Currently these are the insurance companies that we know are NOT in network with Associates in Obstetrics & Gynecology, PC. Seeing an out of network provider means you will end up paying more for your medical care. Please call your insurance to verify in network status.
Medicare Advantage Plans
UMR- Windstream Employees
Humana PPO | HMO | Medicare Advantage
Anthem BCBS Exchange Products- PATHWAY & PATHWAY X | Medicare Advantage (OBAMA CARE THROUGH HEALTHECARE.GOV)
BCBS – United Welfare Fund
United Health Care – Any Plans
Cigna Exchange Products (OBAMA CARE)
Beaulieu Employees- Select Plan & Value Plan
Wellcare / Peachstate /Caresource /Amerigroup Medicare
Aetna – Aetna Premier Care Network – APCN
Employers Health Network – EHN as of 8/20/2020
Cigna Local Plus – In Network/Par as of 1/1/20*
What does it all mean?
Deductible- is the amount the patient pays before their insurance kicks in to pay anything.
Co-Pay- is a fee charged for a type of service regardless of the cost of the procedure. Co-pays do not apply to all services and are subject to the individual plan.
Co-Insurance- is a percentage you pay of the total cost of care. Co-insurance is typically what you pay once your deductible is met and goes towards the out-of-pocket expense.
Max out of pocket expense- is the maximum amount you will pay before all of your medical bills are covered.
I am pregnant. What are the costs for prenatal care?
Obstetric care is billed as a global service. Meaning that we do not bill your insurance for everything you have done. After your first initial visit to establish your pregnancy your global care begins. Most insurances only cover 1-2 routine ultrasounds per pregnancy. Typically this is the first ultrasound and the anatomy ultrasound done at 20 weeks gestation. Your global care covers:
Routine prenatal visits
Post-partum care following delivery
Your global care is billed after you deliver. Should you need additional services during your pregnancy those will be billed immediately as they are not considered “routine care”. These services are, but not limited to, diagnostic ultrasounds, fetal non-stress testing, and problem visits.
After your care has been established with our office we will verify your insurance benefits. We recommend that you call your insurance and inform them of your pregnancy and answer any questions they have. Most insurance companies require notification by the patient of pregnancy.
If you have questions regarding your OB GLOBAL benefits please call the office and ask to speak with our OB Coordinator at 706-278-4640.
The global fee we bill to your insurance is only for our providers services. It does not include any hospital services, anesthesia or radiology. We deliver at Hamilton Medical Center. Please call them for information regarding their fees.
Other Billing and Insurance Information
All major surgical cases require an assistant surgeon to be present during surgery. Should your case require an assistant surgeon we will bill your insurance for that provider.
We are in-network with Medicare. Medicare has strict guidelines as to what is covered and when. If you are at the age of 65 and just received Medicare you may be seen by ONE physician for your “Welcome to Medicare” visit. After that you may been see annually (must be a year to the day) by ONE physician for a routine annual wellness exam. If you have your annual wellness visit with your PCP, you cannot have one with anyone else that year.
Medicare covers Screening Pap/Pelvic & Breast exams every two years. The two years has to be to the date otherwise Medicare will not pay. If you are considered high risk you may have annual pap & pelvic exams.
Your physician will recommend when it is time for you to schedule your screening mammogram. We do not provide mammography services at our location and we do not manage any billing associated with mammograms.