Insurance & billing,
made clearer.
Understanding your coverage can be complicated. Here’s what to know about insurance participation, patient responsibility, billing, and payment at PrimeCare.
Find your insurance plan.
Participation may differ by product, service type, provider, and network. Patients should always verify benefits directly with their insurance company.
These plans are generally accepted for PrimeCare services subject to the patient’s individual plan and network.
These plans may be accepted for Urgent Care but not for establishing Primary Care at PrimeCare.
PrimeCare does not currently participate with the following plans.
Coverage is specific to your plan.
Insurance verification is not a guarantee of coverage. Participation can vary by employer group, product, provider, location, service type, and network.
Urgent Care and Primary Care may process differently under the same insurance plan. Payment of a previous claim does not necessarily confirm that PrimeCare or a specific provider is in-network for future services.
We encourage patients to contact the member services number on their insurance card before receiving non-emergency services when coverage is uncertain.
Not every visit is billed the same way.
Here’s what to know about self-pay, workers’ compensation, and automobile-related care.
Paying without insurance
Self-pay options are available for patients who do not have insurance or choose not to use insurance. Payment is due at the time of service.
Work-related injuries
Employer authorization and workers’ compensation information should be provided whenever applicable. If a workers’ compensation claim is denied, charges may be submitted to private insurance on file when applicable.
Auto insurance claims
PrimeCare does not submit claims directly to automobile insurance carriers. Patients remain responsible for applicable charges.
The details, when you need them.
We’ve organized the most important billing and insurance policies below. Select a topic to review the details.
Insurance participation & patient responsibility
When PrimeCare participates with your insurance plan, we will file claims as a courtesy when complete and accurate insurance information is provided.
- Filing a claim or verifying benefits does not eliminate your financial responsibility.
- You are responsible for understanding your network, PCP, referral, deductible, co-pay, co-insurance, and coverage requirements.
- You are responsible for applicable co-pays, deductibles, co-insurance, non-covered services, and patient balances.
- If PrimeCare does not participate with your plan, you may be considered self-pay unless other arrangements are made in advance.
Referrals & prior authorizations
Some insurance plans require referrals or prior authorization for office visits, medications, imaging, testing, or procedures.
- Patients are responsible for understanding whether a referral is required.
- Services may not be covered if required authorization is not obtained.
- PrimeCare may submit required information, but insurance processing timelines vary.
- Patients should respond promptly to requests from their insurance company or pharmacy.
Claim processing & insurance requests
Patients must provide accurate insurance information and cooperate with requests related to claim processing and coordination of benefits.
- Delayed or denied claims caused by incomplete information or unmet payer requirements may become the patient’s responsibility.
- If an insurer later retracts, reverses, or recoups a payment for a valid reason, the remaining balance may become patient responsibility.
Patient balances, statements & collections
- Patient balances are due within 30 days unless a payment arrangement has been approved.
- Statements and reminders may be sent electronically by text, email, patient portal, or other electronic methods.
- Patients are responsible for keeping contact and insurance information current.
- Delinquent accounts may be subject to collection activity or restriction of non-emergency services.
- Payment arrangements should be made before the account becomes delinquent.
Laboratory & outside service billing
Outside laboratories and other third-party facilities may bill separately from PrimeCare. Patients are responsible for charges assessed by those entities according to their insurance coverage.
Financial responsibility for minors
The parent, guardian, or adult accompanying a minor to the office is responsible for payment regardless of divorce agreements, custody arrangements, or policyholder status.
Returned payments
Returned checks are subject to a $50 returned-payment fee.
Have a question about your account?
Contact the PrimeCare billing team for help with statements, balances, payments, or billing questions.