Insurance & Billing

Insurance & Billing at [Practice Name]

We accept most major insurance plans and offer clear self-pay pricing, so cost is never a barrier to getting care. Check your coverage in seconds, learn what to expect at checkout and find easy ways to pay.

Is my insurance accepted?

Start typing the name of your insurance company to check our in-network list.

Free benefits checkAnswers within [1 business day]HSA / FSA accepted

Accepted Insurance

Insurance Plans We Accept

[Practice Name] is in network with most major commercial, Medicare and Medicaid plans in [State]. Coverage varies by plan, so we always verify your benefits before your visit.

[Insurance Provider 1]

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Also accepted

Don’t see your plan?

This list changes as we add new plans. Call [Phone Number] or bring your insurance card to your visit and we will confirm your in-network status and estimated costs before any care begins.

Coverage Basics

Insurance Terms, in Plain Language

A few terms come up often when you use your insurance. Here is what they mean for your visit at [Practice Name].

Referral

Some HMO and managed care plans require a referral from your primary care provider before you see a specialist. Check your plan or ask us.

Prior Authorization

Certain tests and procedures need approval from your plan first. Our team submits these requests for you.

Copay, Deductible & Coinsurance

Your copay is a set fee per visit. Your deductible is what you pay before coverage starts. Coinsurance is your percentage after that.

Out-of-Network Benefits

If we are not in your network, your plan may still cover part of your visit. We can provide the paperwork to file a claim.

Before Your Visit

Four Steps to a Smooth Check-In

A little preparation helps us verify your coverage quickly and keeps surprises off your bill.

STEP 01

Check your coverage

Use the coverage checker above or call us with your member ID. We will confirm benefits at no cost.

STEP 02

Bring your card & photo ID

Please bring your current insurance card and a government-issued photo ID to every visit.

STEP 03

Get a referral if needed

If your plan requires a referral, ask your primary care provider to send it before your appointment.

STEP 04

Complete forms online

Save time in the waiting room by filling out your new patient forms before you arrive.

No Insurance? No Problem

Simple, Upfront Self-Pay Pricing

If you do not have insurance or choose not to use it, you will know the price before your visit. Self-pay patients pay at the time of service, and our team can help you plan for any follow-up care.

Your right to a Good Faith Estimate

Under the No Surprises Act, patients who are uninsured or not using insurance can receive a Good Faith Estimate of expected charges before scheduled care. Ask us for yours, or visit cms.gov/nosurprises.

Self-pay prices effective [Month Year]. Prices cover services billed by [Practice Name] only.
Service	Self-pay price
New patient visitComprehensive exam and consultation	$[###]
Follow-up visitEstablished patient office visit	$[###]
[Common Procedure][Short description]	$[###]
[In-Office Imaging / X-Ray][Short description]	$[###]
[Diagnostic Test][Short description]	$[###]

Prices do not include outside laboratory, pathology, imaging center or hospital fees, which are billed separately.

Payment Options

Flexible Ways to Pay

Copays and self-pay balances are due at the time of service. Any remaining balance is billed after your insurance processes your claim.

Credit & Debit Cards

We accept Visa, Mastercard, American Express and Discover, in the office or online.

HSA & FSA Cards

Use your Health Savings or Flexible Spending Account card for eligible visits and services.

Payment Plans

Need more time? Ask about interest-free monthly payment plans for larger balances.

Patient Financing

[Optional] Apply for healthcare financing through [Financing Partner] for planned procedures.

Online payments are processed through a secure, encrypted payment portal. We will never ask for card details by email or text.

Understanding Your Bill

How to Read Your Statement

Hover over or tap each part of the sample statement to see what it means. Still unsure? Our billing team is happy to walk through it with you.

[Practice Name]Sample patient statement

Statement date
[MM/DD/YYYY]

1Date of service[MM/DD] · Office visit

2Amount billed$[###.00]

3Insurance paid−$[###.00]

4Plan adjustment−$[##.00]

5Amount you owe$[##.00]

1
Date of service
The day you were seen and the type of visit. Make sure it matches your records.
2
Amount billed
Our standard charge before insurance. Most insured patients never pay this full amount.
3
Insurance paid
What your plan paid us. You will see the same amount on your Explanation of Benefits (EOB).
4
Plan adjustment
The discount your insurance negotiated with us. You are not responsible for this amount.
5
Amount you owe
Your share, such as a copay, deductible or coinsurance. It should match the patient responsibility on your EOB.

Billing Questions?

Our billing team can explain a statement, set up a payment plan or resubmit a claim to your insurance.

FAQ

Insurance & Billing Questions

Can’t find what you are looking for? Call our billing team at [Billing Phone Number].

Do you accept my insurance?

We are in network with most major plans, including those listed on this page. Because benefits vary by plan, we verify your coverage before your first visit. Use the coverage checker above or call [Phone Number].

Do I need a referral to be seen?

It depends on your plan. Many PPO plans do not require one, while HMO and some Medicare Advantage or Medicaid plans do. Check the back of your insurance card or ask our team.

What if [Practice Name] is out of network for my plan?

You can still be seen. Your plan may cover part of the visit through out-of-network benefits, and we can provide the documents you need to file a claim. Self-pay pricing is also available.

What if I don’t have insurance?

We offer transparent self-pay pricing for common visits and services. You also have the right to request a Good Faith Estimate of expected charges before your scheduled care.

When is payment due?

Copays, known deductibles and self-pay fees are due at the time of your visit. After your insurance processes the claim, we will send a statement for any remaining balance.

Why did I get a bill after my insurance paid?

Your plan may have applied part of the charge to your deductible or coinsurance. Compare your statement to your Explanation of Benefits from your insurer, or call us and we will review it with you.

Do you offer payment plans?

Yes. If you have a larger balance, ask our billing team about interest-free monthly payment plans.

Can I use my HSA or FSA card?

Yes. Most visits and services are eligible expenses under Health Savings and Flexible Spending Accounts.

Questions About Coverage? We’re Here to Help

Our team will verify your benefits and explain your costs before your visit, so you can focus on feeling better.