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Making Sense of Your Insurance: A Guide for MFM Health Patients

At MFM Health, we believe informed patients are empowered patients. Navigating health insurance can feel overwhelming, but taking the time to understand your benefits is crucial for ensuring a smooth healthcare experience. While we’re here to assist with questions, it’s important to take an active role in managing your coverage to avoid unexpected costs.

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Why It’s Important to Understand Your Benefits

Better understanding means better care.

Knowing the details of your insurance plan allows you to make informed decisions about your care, prevent billing surprises, and focus on your health without added stress.

Understanding your insurance helps you:

  • Confirm which services are covered.

  • Identify in-network providers, including those at MFM.

  • Anticipate any copays, deductibles, or out-of-pocket costs.

Your Role in Managing Insurance Coverage

At MFM Health, we’re happy to answer general questions, but as the patient, you are responsible for:

  • Verifying Coverage: Contact your insurance company to confirm that services and providers are covered.

  • Understanding Costs: Familiarize yourself with copayments, deductibles, and any out-of-pocket maximums.

  • Staying Informed: Check if prior authorizations or referrals are required for certain services.

Reach Out to Your Insurance Carrier

Before scheduling an appointment, contact your insurance company to confirm your coverage and estimated costs.

Bring Your Insurance Card

Always bring your most current insurance card to your appointments at MFM Health.

Know Your Plan Details

Familiarize yourself with the terms of your plan, including in-network providers and specific coverage limitations.

Helpful Tips for Navigating Insurance

Please let our team know at your next visit if you have a new insurance card, so we can scan an image of your new card into your patient chart.  You may also add images of your new insurance card through the patient portal.

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Find Your In-Network Provider

To help you in this process, we've provided links below to the major insurance company websites where you can easily access their find-a-provider look-up tools. These tools allow you to search for providers by name or location, making it simple to find our practice and the providers within it.

Simply click on the link corresponding to your insurance provider, and you'll be directed to their website where you can begin your search.

 

If you have any trouble accessing or understanding your insurance benefits, don't hesitate to reach out to your insurance provider directly by calling the member services phone number on the back of your insurance card.

We’re Here to Help

If you have questions about billing or general insurance inquiries, our team is here to assist. However, to ensure the most accurate information, contacting your insurance company is the best first step. Taking the time to understand your insurance benefits puts you in control of your healthcare journey. Together with MFM Health, you can achieve better health outcomes with fewer surprises.

  • How do I know if my insurance was billed correctly?
    Once your insurance has been billed, you will receive an Explanation of Benefits (EOB) from your insurance company. This document explains what services were billed, how much your insurance covered, and any remaining balance that you may owe. If you have any questions or feel there was an error, please contact our billing office.
  • Can I set up a payment plan for my bill?
    Yes, we offer flexible payment plans to help patients manage their medical bills. Please contact our billing department to discuss available options.
  • Who do I contact if I have questions about my bill?
    For any billing inquiries, you can reach our billing department. Our team is happy to assist with any questions regarding charges, insurance, or payment options.
  • What should I do if my insurance information has changed?
    If your insurance information has changed, please notify us as soon as possible to ensure accurate billing. You can update your insurance details by contacting our billing office.
  • What happens if my insurance denies a claim?
    If your insurance denies a claim, you will receive a notification explaining the reason for the denial. Our billing department can assist you in understanding the reason for the denial and provide guidance on how to appeal the decision if necessary. You may also be responsible for the balance if your insurance company does not cover the service.
  • Do you bill secondary insurance?
    Yes, if you have secondary insurance, we will submit claims to both your primary and secondary insurance providers. Please ensure we have up-to-date information for all of your insurance plans.
  • Why do I have to pay a copay if I already met my deductible?
    Your deductible is the amount you need to pay out-of-pocket before your insurance starts covering certain services. However, copays are separate fees required for specific services, such as office visits or specialist consultations, and are often required regardless of whether you’ve met your deductible. Please contact your insurance company for more information about your out-of-pocket payment responsibilities.
  • Why am I receiving multiple bills for one visit?
    You may receive separate bills for different services provided during your visit. For example, a lab test or imaging service may be billed separately from your MFM Health office visit. If you have any questions about specific charges for services you received at an MFM Health location, feel free to contact our billing office for clarification. If your MFM Health provider orders testing or imaging at an external, non-MFM Health facility, those services will be billed separately by the outside provider. For any questions or concerns regarding bills for these services, please contact the billing department of the external facility directly.
  • Can I receive an estimate for my out-of-pocket costs before my visit?
    Yes, we can provide a cost estimate for many services. Please contact our billing office before your visit to request an estimate based on your insurance plan and the services you may need.
  • How can I dispute a charge on my bill?
    If you believe there is an error on your bill, please contact our billing department as soon as possible. We will review the charges and work with you and your insurance company to resolve any discrepancies.
  • Will I be billed for missed appointments?
    Yes, missed appointments without proper notice may result in a fee. We ask that patients cancel or reschedule at least 4 hours in advance to avoid being charged for a missed visit. Please see our No Show/Late Arrival policy for more information.
  • Why do I have to pay out-of-pocket when my insurance didn’t cover the full amount?
    Insurance companies have coverage limitations based on your specific plan. If a service is not fully covered, or if it’s considered out-of-network, you may be responsible for the remaining balance. Our billing team is happy to help clarify what your insurance covers and for what portion you are responsible.
  • Why did I receive a bill for my annual exam?
    You may have received a bill for your annual exam because certain services performed during the visit may not be covered under your preventive care benefits. Annual exams are typically covered in full as preventive care; however, if additional issues were addressed, such as new concerns, chronic condition management, or diagnostic tests, these may fall outside of preventive coverage and be billed separately. For a detailed explanation of what may impact your bill, visit our blog post here: Why Did I Get a Bill for My Annual Exam?
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