Insurance Info

707 N Fielder Rd Suite A, Arlington, TX 76012

Arlington Family Health Pavilion

Your trusted local Primary Care Physician

What does "accepted" mean?

"Accepted"

"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.

Plans currently accepted

Traditional Medicare (Established patients only: RED, WHITE, & BLUE CARD)
Advantage Medicare Plans (AARP, Secure Horizons, United Healthcare, Humana Medicare, Aetna Medicare, Humana Gold Choice, Care Improvement, CareN'Care, BCBS Medicare PPO plan only.)
United Health Care: Most plans
Cigna: Open Access, Choice Fund
Aetna: Open Access, Choice POS II, AOP (NO Baylor Scott & White)
BCBS PPO
BCBS HMO (PCP: Dr. Ledesma / Dr. Rodgers, this must be changed before scheduling)
Multiplan
Humana
UMR
UHSS
PHCS
GEHA
RSL
Tricare Standard (As a Secondary ONLY)
Any small insurance plans administered by larger companies we accept. If we are in network with the larger administering company, our office should be able to accept your insurance. Please call to confirm your eligibility.

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.

When you arrive

We ask that you present your insurance card at each visit. It is your responsibility to provide us with the correct information to bill your insurance.
If you have a change of address, telephone numbers, or employer, please notify the receptionist. Updating your contact information is important, as we provide you with results and important information pertaining to your health.
All deductibles, co-payments, co-insurance, or charge for non-covered services are due at the time of the office visit, no exceptions. If you have questions regarding your appointment and your patient responsibility, please call in advance for clarification.

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.

HMO-PPO PATIENTS

If we participate with your plan

We will file your insurance for you. Your co-payment or deductible will be collected at the time of service no exceptions.

If your plan requires you to choose a primary care physician

It is your responsibility to make sure your insurance company has the physician you are seeing in your office as your PCP.

If your plan requires you to have authorization to see a specialist

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.

If we do not participate in your plan

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.

MEDICARE ADVANTAGE PATIENTS

We only accept Medicare Advantage patients at this time.

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.

All Medicare patients

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.

Supplemental/Secondary insurance

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

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.

SELF-PAY PATIENTS

Patients with no insurance

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

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.

PHARMACEUTICAL Patient Assistance

Arlington Family Health Pavilion can assist you with your pharmaceutical patient assistance if needed if you do not have any insurance.

Coverage Rejection

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.

Delinquency

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.