Insurance Information

We accept many types of health insurances so be sure to bring your insurance card with you to your first visit. You are also welcome to fax or email it ahead of time. Insurance is getting more and more complicated every day and we often find that patients have trouble navigating the insurance waters to find out exactly what benefits they have. We have trained insurance specialists that communicate directly with your insurance provider asking the specific questions to get all the pertinent answers. Let us do the hard work for you.

PPO Insurance

Preferred Provider Organization

We accept many PPO insurances that have “out of network” benefits.  We are likely NOT in your network – and for good reason. (see below). Your particular plan will be thoroughly checked so you will know everything necessary concerning any out of pocket costs BEFORE you incur them. You see, our office has a NO WORRY financial policy which promises that we tell you about any out of pocket charges ahead of time. That means you can rest assured you are not running up a bill without knowing it. Our initial screening (discussion) with you is used to determine if you are in the right place and to discuss any costs that may be associated with your visit that day. Depending on your policy, you may never have to pay out of pocket, or you may only have a copay. We will always tell you ahead of time. Examples of commonly accepted insurances are: (If your plan is not on this list, we probably still accept it)

Examples of commonly accepted insurances

(If your plan is not on this list, we probably still accept it)

  • UNITED HEALTHCARE
  • CIGNA – Unless it utilizes ASH
    (American Specialty Health)
  • AETNA
  • ANTHEM BLUE CROSS
  • BLUE SHIELD OF CALIFORNIA
  • BLUE CROSS/BLUE SHIELD (ALL STATES)
  • SAG
  • DIRECTORS
  • PRODUCERS
  • MOTION PICTURE
  • WRITERS GUILD
  • MEDICARE
  • USC/UCLA STUDENT/FACULITY
  • THE HARTFORD
  • NEW YORK LIFE
  • CNA
  • HUMANA
  • SAFECO
  • NATIONAL LIFE
  • ALL AUTO INSURANCE MEDPAY POLICIES
  • MANY OTHERS

HMO Insurance

Health Maintenance Organization

If you have an HMO, you probably know there can be a big difference in service coverage between HMOs and PPOs. With that being said, HMOs do not often reimburse for care in our clinic (there are occasional exceptions). The reality is that HMOs are not generally designed to deliver patients quality, specialized rehabilitation services similar to what we offer. With that, we have many, many patients with HMO plans getting tremendous results in our clinic. We simply work out a care plan any way we can to make sure everyone who needs and wants care will receive it.

Special Note

Insurance coverage (good, bad, or ugly) is by no means a prerequisite for care in our clinic. Up to 50% of our patients are either uninsured or underinsured, but are still getting care. Our commitment is to make every effort to get everyone who needs care the care they need.

West LA Physical Medicine has a “no worry” financial policy and accepts most insurances.

IMPORTANT ANSWERS ABOUT YOUR INSURANCE

3 COMPONENTS OF YOUR HEALTH INSURANCE

Deductible

This is the amount your insurance company expects you to pay out of pocket BEFORE they start paying according to your policy. It applies to all providers for the calendar year, so if you pay it to one doctor or facility, you do not have to pay it to anyone else for that year.

 

Almost all insurances only apply the amount they would have paid to the provider to the deductible. So if you pay $125 for a service, but your insurance would only reimburse the office $50 for the same service, then they generally only apply the $50 toward your deductible.

 

When there are services applied to the deductible, this means the clinic DID NOT get paid for those services. That is why the clinic collects those amounts directly from the patient.  You never owe your insurance company the deductible. The only thing you ever owe them is your monthly premium. If for some reason you pay the clinic for deductible payments that were applied by another clinic, then that money is refunded to you.

Co-Pays/Co-Insurance

Your insurance typically pays for only a certain percentage of any service or procedure, the rest is your responsibility- this is called Co-Insurance. Or your insurance can specify a set amount you have to pay each time – this is called a Co-Pay. Either way, our clinic will always let you know what this amount is ahead of time.

 

Remember, our clinic is most likely NOT in-network with your insurance. This is a choice we make to insure that you are given the best possible care and that we have autonomy in the decisions we make regarding treatment.

 

Even though your treatment will generally be much more comprehensive and involved than most patients ever experience within their network, we are often able to keep out of pocket costs similar to those in-network.

Insurance Payments

Reimbursements from your insurance company to the clinic are made for the care you received in the clinic and are separate from the deductible and co-pays/co-insurance.

 

Depending on your insurance company, they will send payment for your services directly to our clinic or in some cases they will mail it directly to the patient. If they send payment directly to you, this means the clinic DID NOT get paid for your care. These reimbursement need to be brought in attached to the explanation to be applied to your account. 

 

These payments ARE NOT to make up for what you have paid toward the deductible or co-pays – which are separate costs based on your coverage.

WHY IS OUR CLINIC NOT “IN-NETWORK”

The Short Answer? Because we do not want your insurance company dictating the care you receive in our clinic. We give our patients world-class care and nobody gets to interfere with that.

 

A More Detailed Answer?  Your insurance company goes to great lengths to persuade you to use a network provider even to the point of printing it on your benefits card that your “out-of-pocket costs will be greatly reduced” by staying in-network. Have you ever wondered why? The fact is, In-network doctors and clinics agree to be paid substantially less by your insurance company in exchange for being in the network. They also agree to generally only deliver care in accordance to how the insurance company wants it delivered or they do not get paid. This is much like the HMO model, but with a different name. These recommendations are driven COMPLETELY by supposed cost savings and nothing else – and are often reflected in poorer results and decreased patient satisfaction.

 

There is a reason insurance companies still offer out-of-network coverage – patients demand it. Nationwide, patient satisfaction with providers that are not contracted with insurance companies is significantly higher. This often has to do with the fact out-of-network providers place patient care, instead of insurance company cost priorities and mandates, as their primary concern.

 

Our clinic is often able to approximate out of pocket costs to that of the network – even while providing substantially superior care. This can be achieved through better results in fewer visits,  single co-pays even when utilizing multiple disciplines or simply matching in-network copays to name a few.