Check on insurance

pregnant woman reviewing medical bill on couch speaking to husband

Check on insurance

Below are answers to some frequently asked questions about health insurance

What if I don't have insurance?

If you don’t have insurance, you will be required to pay a portion of the cost for your medical care at the time of your appointment. For office visits at Prevea, you will be required to pay a minimum of $150 at the time of each visit. If your office visit involves any X-rays, you will be required to pay a minimum of $225 at the time of each visit. You will be billed for any remaining balance. For surgeries, procedures and diagnostic testing you are required to pay a minimum of 40% of the estimated cost before the appointment. This can be paid with cash, debit or credit card at the time of service. Payments made by check are required 14 days prior to service. More information on Prevea’s billing practices is available here.

Good Faith Estimate

You have the right to receive a “Good Faith Estimate” if you do not have or are not using insurance. More information on Good Faith Estimates can be found on the Paying for your visit page.

Looking for insurance?

There may be options available for you to enroll in or purchase insurance or other coverage through the Federal Health Insurance Marketplace and various state programs to help with the cost of your care with Prevea Health. If you’d like more information on what options may be available to you, contact Prevea's Patient Advocate.

(920) 405-1445

What insurance networks does Prevea accept?

Many health care services provided at Prevea Health are covered by health insurance. We gladly file claims on your behalf. Prevea has a list of insurance partners who provide coverage for physicians, providers and services at our Prevea health centers and partner hospitals available here. This list also includes some Medicaid and Medicare plans, and more information about Medicare plans is available here.

What does in-network and out-of-network mean?

Prior to scheduling an appointment, you should verify your health insurance benefits with your insurance company. You are responsible for confirming whether the physician, provider and/or health center you are planning to receive care at is in-network with your insurance plan.

Health care organizations, physicians and providers are considered “in-network” when they have an agreement with your health insurance plan. This means the organization has a contract with the insurance company, which leads to savings and/or discounts on services for patients. This can also be called “participating providers.” Information on which providers and organizations are in-network for your insurance plan is available from your insurance company.

If your insurance plan does not accept a provider or health center, they are considered “out-of-network.” In this case, the patient is often responsible for the full amount billed for the service they receive. Some health insurance plans cover both in-network and out-of-network care, but in-network care is often still more cost-effective for patients.

For some specific circumstances, such as if you are seeing a specialist, even if the provider you would like to see is in-network with your insurance plan, your insurance company may require a referral from another provider, pre-certification or prior authorization to cover the cost of the services. Please contact your insurance company before scheduling an appointment with a specialist.

Your insurance premium is the amount you pay monthly, semi-annually or annually directly to your health insurance company. This is the cost you pay to belong to your insurance plan.

Your deductible is the amount you will pay toward medical expenses before your insurance covers any costs. This is paid to the health care organization where you received care. You will be responsible for paying for your medical care until you hit your deductible amount before your insurance plan starts to pay for your costs.

After you reach your deductible, your insurance may start splitting some of your medical costs with you. This is called coinsurance. This is when you pay only a percentage or part of the total cost for your service and then your insurance company will pay the rest. This is paid to the health care organization where you received care.

The out-of-pocket maximum is the amount you will pay for health care services before your insurance company starts completely covering all covered expenses. This includes your deductible and any amount of coinsurance you have paid to your health care physician, provider or organization.

Co-payments, or copays, are fixed amounts that are paid to your health care physician, provider or organization at the time of your appointment for some services and prescriptions. These costs are outlined in your health insurance plan. If your insurance plan requires a co-payment for your service, you will be asked to pay the required amount when you check in for your appointment. More information on co-payments can be found here.

What are HSAs (Health Savings Accounts) and FSAs (Flexible Spending Accounts)?

Health Savings Accounts (HSA) and Flexible Spending Accounts (FSAs) are special accounts that can be used to pay for approved medical expenses. These accounts let you set aside money to pay for health care services, deductibles, co-payments, coinsurance and other approved expenses. If your insurance plan offers an HSA and/or FSA, they will also outline which health care expenses are approved and can be paid for using these accounts. Check with your health insurance company to learn more about these accounts.

Have additional questions about billing?

If you have additional questions about billing and insurance, you can:

Click here for more information.
Call Prevea Patient Accounts at (920) 496-4775 or (888) 477-3832 to talk to someone, 8 a.m. to 4:30 p.m., Monday through Friday.
Send us a message through MyPrevea.

Knowing your health care costs

One of the biggest questions you might have when seeking medical care is, “How much is this going to cost?” The best way to find out what your medical care is going to cost is to request an estimate before your appointment. There are a few ways to do that.

Learn more