"Accepted" means that Arlington Family Health Pavillion has agreed to provide care to the insured of a particular insurance program. Although we would like to participate in all insurance plans, this can be difficult. We must take into considerations the availability of hospitals, specialists, and referral restrictions.
Note: This is not intended to be a complete detailed list. All AFHP physicians may not participate in every health plan and AFHP may not be contracted for every product offered by each health plan. There are plans that are part of “groups” that AFHP may not participate with.
Your insurance is a contract between you, your employer, and the insurance company. It is very important that you understand the benefits and provisions of your policy.
If your insurance company pays only a portion of the bill or rejects your claim, an EOB (Explanation of Benefits) should be made available to you, or the policyholder via your preferred method of communication.
If you have a balance from a previous visit, we will also ask for that payment. Any payments made will be applied to the oldest balance existing on your account at the time.
If we do not participate with your insurance company, you will be expected to make payment in full at the time service is rendered. As a courtesy, for most insurance companies we will file the claim to your insurance carrier, and they will reimburse you directly.
We take all credit cards (Discover, Visa, Mastercard, American Express ), as well as cash. Unfortunately, we do not accept CARE Credit at this time.
If you come to the office for a lab draw, you must present your card to the front desk so they can submit it to Quest Diagnostics for processing of your lab work.
Quest Lab hours:
Monday - Thursday: 7:30 am - 12:30 pm; 1:00 pm - 4:00 pm
Friday: 7:30 am - 12:30 pm
We will file your insurance for you. Your co-payment or deductible will be collected at the time of service no exceptions.
It is your responsibility to make sure your insurance company has the physician you are seeing in your office as your PCP.
You must schedule an appointment with the office for referral processing, and documentation for the need of your specialist referral. No retroactive referrals will be given.
We will verify your out-of-network benefits, file your charges, and will expect payment of your portion of the charges at the time of service. If we are not your primary care physicians, we will not be able to obtain an authorization to see a specialist or admit you to a hospital.
We are participating providers with Medicare Advantage plans and will your Medicare Advantage for all your covered charges. Traditional Medicare is ONLY accepted for established existing patients only.
Whether you have supplemental or secondary insurance: It is important that your know which insurance is your primary paying and your secondary paying insurance. Our office will not know how your plans have been set up, we have not have any access to that information.
If you have supplemental/secondary insurance, any balance remaining after primary payment will be forwarded to them for payment consideration. If payment is not received from your supplemental/ secondary insurance within 45 days of being submitted, we will bill you for the balance due.
If you do not have supplemental insurance, a portion ( Medicare deductible amount to be met or 20% of the amount allowed by Medicare Advantage) will be collected at the time of service. Each year you will be expected to pay the allowed amount of your charges until your Medicare Advantage deductible is met.
If you have a Medicare Advantage plan with a copay, that copay will be collected at the time of service.
Patients with no insurance will be expected to pay IN FULL at the time of service. Cash discounts will only be applied on the day of service.
If you will not be able to pay in full, please contact the appointment desk to reschedule your appointment. Unfortunately, AFHP does not make any payment arrangements.
Arlington Family Health Pavilion can assist you with your pharmaceutical patient assistance if needed if you do not have any insurance.
Reduction or rejection of your claim by your insurance does NOT relieve you of your financial obligation.
We will do everything possible to make sure that the services we provide to you are covered by your plan; however, each policy is different and insurance companies DO NOT guarantee payment, even though you may have benefits.
Please know that we only order testing or medications that we feel are medically necessary in your individual case, but insurance companies can make decisions about medical necessity within their company guidelines. Also, please understand that the employers can include or exclude items in the company policies when they contract with the insurance company.
If you ever have any questions about insurance coverage, relating to the treatment you are receiving, please call your insurance company and ask them to explain your benefits to you.
Remember, whether you do or do not have insurance, you are ultimately financially responsible for payment of your charges.
If your insurance denies our charges or does not pay us in a timely manner, or if your account becomes delinquent, we reserve the right to refer your account to a collection agency and be to report to the credit bureau.
If you have a spouse that is a patient here and you both share an account together, any balance due is both parties’ responsibilities. Not one person or the other. Any balances due will be expected to pay in full at the time of service.
If you are a separated or a divorced family, and your child is a patient, please keep in mind that all co-pays/balances are due at the time services are rendered. We will not be involved in any personal disputes or any court orders.
Motor vehicle accidents will have to be paid IN- FULL at time of visit. Insurance cannot be used if filing a claim with your/their car insurance.
We do not accept ANY work-related injuries. We can refer you to a doctor that accepts work-related cases.
Effective March 1, 2022, patient's with no insurance, self-pay patients will see an increase in cost for services rendered.
Effective April 1, 2022. The office will no longer be accepting new patients who are insured by a commercial plan. Our practice will remain open for NEW MEDICARE ADVANTAGE patients.