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Policy Guidance

Insurance

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The Allergy Clinic participates with over 200 different insurance companies. Each plan is different in the medical services they cover, patient copayments charged, payment deductibles, and how referral medical services such as laboratories, hospitals, and medical specialists are obtained. Most insurance companies have a directory of physicians from which you can select your physician. Check your Insurance Company Physician Directory to see if our Pediatricians are listed!

Most insurance plans can be broken down into three types:
Health Maintenance Organization (HMO)
· An HMO usually requires that you select a doctor to be your Primary Care Giver (PCP). You are usually required to see this doctor for all of your medical care needs. If you need to see a specialist your PCP will usually accomplish a referral (approval form from the insurance company) to see another physician. This insurance plan will have a list of doctors from which you can choose. You will usually have a copayment to pay for each doctor visit.
Preferred Provider Organization (PPO)
· A PPO plan usually allows you to see any doctor you wish or it may require you to see certain doctors that the insurance plan has selected. Your PPO plan may or may not require a referral or pre-authorization for medical services. You may or may not have a copayment amount that must be paid prior to each doctor visit.
Indemnity Plan
· This plan usually allows you to see any doctor you wish or at times only doctors who are members of the plan. You will usually have a deductible (an amount that may range from $100 - $500) and a percentage of charges to pay after your deductible is met.
The clinic administrative and nursing services staff will assist you in understanding your insurance coverage and medical services. Remember it is really up to you to understand what your insurance does and does not cover.Please read your insurance plan policy and contact them with information about coverage or payments that you do not understand. You are responsible for paying amounts that are owed by you or for services that are not covered by your insurance plan.
Here are some things to ask your insurance company:
1. Do I need a referral or pre-certification to see the Allergy doctor? If a referral is required it must start on the day of your first appointment and continue for the length of your treatment service. A referral will usually also state the service they have approved for your medical care episode.
2. Does my policy cover allergy testing, serum mixing, injections if required sick and well child visits? Some insurance programs may not cover payment for certain treatment items. For example, the insurance may pay for the consult with the doctor but not allergy shots if they are recommended. Some plans may also have higher deductible amounts or cost share amounts for certain services. For example, allergy shots may be covered but the serum mixing for the allergy shot may have a deductible amount you must meet.
3. Does my policy require me to see certain doctors for special care? For example some insurance plans may allow you to see only select specialist physicians. Some of the specialist physicians may also be located some distance from your home. Some insurance plans may not have physicians in all special medical care fields that you require or have doctors listed who are no longer accepting your insurance. 
4. How long do I have to wait for a medical condition before I can be seen? Some insurance plans may have pre-existing medical condition coverages. This means you must wait a period of time before a previously treated condition will be paid by the insurance company.
The clinic staff will assist you in verifing your insurance coverage at each visit. If your insurance coverage has changed please let the staff know upon your check-in. We will submit bills to your insurance company for you. The clinic staff will also ask that you pay any copayments, balances, deductibles or cost shares you owe upon check in at the clinic for each patient visit. We have signed contracts with the insurance companies that require us to collect these amounts during your visits ( or we could be in default of the contract).
Remember to bring in your insurance cards for each insured member.
Remember it is your responsibility to understand what your insurance does and does not cover. The clinic staff will assist you as much as we can in understanding your insurance coverage, your payment requirements, or how to arrange payment plans.
Check your Insurance Company Physician Director to see if our Pediatricians are listed!   If you are unsure just give the clinic a call (817) 735-2583 and we can answer many questions that you may have.
  • This plan usually allows you to see any doctor you wish or at times only doctors who are members of the plan. You will usually have a deductible (an amount that may range from $100 - $500) and a percentage of charges to pay after your deductible is met.
The clinic administrative and nursing services staff will assist you in understanding your insurance coverage and medical services. Remember it is really up to you to understand what your insurance does and does not cover.Please read your insurance plan policy and contact them with information about coverage or payments that you do not understand. You are responsible for paying amounts that are owed by you or for services that are not covered by your insurance plan.