CORE accepts most insurance plans as well as Medicare and Medicaid. Our staff will help you with clarification of insurance benefits, co-pays and deductibles.
For questions please call us at 918-701-2300.
Here are some simple answers to common questions about basic insurance benefits:
Q: What is the difference between an In Network and Out of Network provider?
A: Network providers have contracted with your insurance company and have agreed to accept a specific fee schedule, known as Allowed Charges, for the medical services you are provided. Network providers have agreed they will not bill the insured for any amount greater than their insurance plan’s Allowed Charges for eligible medical services and supplies.
Out of Network providers do not have a contract with your insurance company and are not limited to your health plan’s Allowed Charges amount. The insured is responsible for all billed charges.
Q: What is a co-pay?
A: A co-pay is a set amount a member pays for a specific service, such as a set dollar amount for a doctors office visit.
Q: What is an Allowed Charge amount?
A: The maximum dollar amount allowed for a service or supply covered by your insurance plan.
Q: What is a deductible?
A: A deductible is the initial out-of-pocket amount that a member pays on ALLOWED CHARGES before a benefit is paid by your insurance company plan benefit.
Q: What is co-insurance?
A: Co-insurance is also known as the patient portion of payment. Co-Insurance is the portion of eligible expenses the member is financially responsible for, usually based on a fixed percentage. Deductible amount must be met before co-insurance applies to the patient.
Q: What does out-of=pocket maximum mean?
A: The out of pocket maximum is the total amount of allowed charges that a member will be responsible for, before their insurance plan pays 100 %. Not all member expenses apply towards the out-of-pocket maximum.
Q: What is pre-certification?
A: Pre-certification is a review process the insurance company may require for certain services such as inpatient hospital admissions, outpatient surgery, or in some circumstances diagnostic tests.
The patient services may not be covered by full plan benefits if pre-certification is not obtained prior to services being rendered.
Note: Pre-certification can take up to 3 days with some companies prior to a scheduled admission.