Frequently Asked Questions

• A formulary is a list of prescription medications covered by your insurance plan, divided into tiers:

  • Generic medications: Lowest co-pay.

  • Preferred brand medications: Higher co-pay than generics but lower than non-preferred brands.

  • Non-preferred brand medications: Highest co-pay.

  • Specialty medications: Used for complex conditions, may have a higher co-pay or require prior authorization.

A deductible is the amount you must pay out-of-pocket before your insurance starts covering services. For example, if your deductible is $1,000, you must pay that amount first. Afterward, your insurance begins covering a portion of your costs, often requiring co-pays or co-insurance.

• Co-pay: A fixed amount you pay for a specific service (e.g., $20 for a doctor's visit).

• Co-insurance: A percentage of the total cost of a service you pay after meeting your deductible (e.g., paying 20% while your insurance covers 80%).

• Check the formulary list provided by your insurance company.

• Contact your insurance company directly.

• Ask our clinic staff for assistance in checking coverage for your prescriptions.

An HSA is a tax-advantaged savings account for paying qualified medical expenses. You can contribute pre-tax dollars, and withdrawals for eligible medical expenses are tax-free. HSAs are often paired with high-deductible health plans (HDHPs).

An EOB is a statement from your insurance company detailing the services you received, how much was billed, what the insurance paid, and what portion you owe. It helps you understand how your claim was processed.

• Review the bill and compare it to your EOB.

• Contact our billing department to discuss discrepancies and email a copy of any statement to office@broadwaydoctor.com.

• Provide relevant documentation or details supporting your claim.

• Follow up with your insurance company if necessary.

Out-of-network services may be covered at a lower percentage or not at all, depending on your plan. You might be responsible for the difference between what your insurance covers and the total bill. Always check with your insurance provider and our office before receiving care.

• Check your insurance plan details for co-pays, deductibles, and co-insurance rates.

• Contact our billing department for an estimate based on the services you will receive.

• Review your insurance company's cost estimator tool, if available.

• Ask about payment plans or financial assistance options.

• Explore potential financial assistance or charity care programs.

Many insurance plans cover preventive services at no cost to you, even if you have not met your deductible. Preventive services might include annual physical exams, screenings, and vaccinations. Check with your insurance provider or our office for specifics on coverage.

Yes, many insurance plans cover telehealth services, including virtual visits with our providers. Coverage and co-payments may vary. Contact our office or your insurance provider to confirm telehealth coverage.

Balance billing occurs when you are billed for the difference between what your insurance pays and the provider's charge. This is more common with out-of-network services. Review your EOB and discuss any balance billing issues with our billing department.

Regularly review your medical bills and insurance statements to ensure accuracy. Compare bills with your EOB, check for errors, and address discrepancies promptly to avoid unexpected charges.

• Review the denial notice and the reason provided.

• Contact our billing department for assistance and clarification.

• Appeal the denial with your insurance company if necessary, following their appeals process.

• A primary care referral to a specialist occurs when your primary care doctor determines you need specialized care. The process usually involves:

  
  

  • Discussing your health issue with your primary care doctor.

  • Receiving a referral from your primary care doctor to see a specialist.

  • Scheduling an appointment with the specialist.

  • Ensuring the referral is approved by your insurance, if necessary, to avoid additional costs.

• Fill out new patient forms, including your medical history.

• Provide your insurance information and ID.

• Receive a thorough evaluation by one of our primary care providers.

• Discuss your health concerns and receive a personalized care plan.

• Friendly staff ready to assist with any questions or concerns.

• Your insurance card and a valid ID.

• A list of current medications you are taking.

• Any relevant medical records or information about your medical history.

• A method of payment for co-pays or other fees.

• Schedule an appointment with your primary care provider at Broadway Family Clinic.

• Discuss your health concerns and the need for a specialist.

• Obtain a referral from your primary care provider if necessary.

• Ensure the referral is approved by your insurance if required.