Exclusions in your policy’s fine print.

Your plan may not cover certain medically recommended tests and services. The list of what your insurance will not cover is growing but is hidden in the fine print. The exact terms of your coverage is between you and your insurance company.

You haven’t met your deductible.

Each year you have to pay your deductible out of pocket before your coverage kicks in. Add your annual deductible to your annual premium, and that’s how much you pay out of pocket before your insurance company pays a dime.

Your doctor was out of network.

Although your physician is contracted with the carrier, your plan may have excluded your physician from the network. This has nothing to do with your physician charging high “out of network” fees, and has everything to do with preventing you from finding treatment.

Your medical plan isn’t covering enough.

Your insurance plan decides how much they pay out of network providers. This “allowable amount” has nothing to do with the cost of providing the service and is rarely enough to cover the bill.

Bill from an outside lab or imaging center.

Your plan may not pay for certain lab tests and imaging.

Our office is not involved in billing for lab tests or imaging provided by external facilities. If your insurance company doesn’t cover their bill, and it’s forwarded to you— your healthcare provider cannot change the reason (diagnosis code) the diagnostic service was ordered in your medical record.

If you’re left stuck with the bill— Our advice is to request a discounted amount without the confusing, overinflated insurance charges since you are paying them directly. (If necessary, mention the recent legislation on cost transparency.)

Our Discount Pricing Info >