PAYMENT POLICY

We do our best to assist our patients as they navigate the rapidly changing health insurance industry. It is critical that each patient  familiarizes themselves with each particular health plan, and what is covered and not covered, as plans vary significantly. 

 

Medical services are provided and billed directly to your plan by our practice. We participate in most all of the major health insurance plans in the region. Following are the health plans which we currently accept.  

 

If your plan is not listed, we will be unable to file a claim on your behalf.  However, we can provide you with a form that you can submit to your insurance company to instruct them to send reimbursements directly to you.  Please feel free to speak with our office if you have any questions.

 

Please be aware that with any health plans, there may be deductibles and copayments for which you could be responsible.

 

Self-Pay Services are also available.  Please speak with our staff for details.

 

PARTICIPATING HEALTH PLANS

Garcia MD PA accepts and will bill out to many insurance companies. It is always a great idea to contact your insurance company to see if Garcia MD PA is a contracted provider. Knowing your benefits is very important and with so many different levels of coverage available, it is hard for us to keep up with all of it.  Calling your insurance company directly is the best way to anticipate what will be covered or what will be patient responsibility.

 

Availability of providers in your plan network is not guaranteed by the insurance carrier and is subject to addition, deletion or change by the insurance carrier at any time without prior notice. Patients must contact their chosen insurance carrier directly for updated information.

 

 

We accept the following health plans when we are listed as your SPECIALIST:  

 

AvMed*

(we take PH, HM, EN, MC, PC, PA, PS, HA, IP plans)

BC/BS

(exlucing Medicare BC/BS plans)

Beechstreet

CarePlus*

(Medicare)

Cigna

(Plans Accepted:  HMO, Open Access Plus, ChoiceFund OA Plus with CareLink, PPO)

First Health

GHI  (PPO only)

Great West  (PPO only)

Guardian  (PPO only)

Healthsun* (Medicare)

JMH Plan

(w/an RX from PCP, do not accept Medicare Advantage plan)

Key Insurance Plan

Medica

(Medicare plan only)

Medicaid

(Clear Health, Positive, Molina, Sunshine State Health.  Do NOT take Medipass, Coventry)

Medicare

(We are specialist for all plans; do NOT take UHC Medicare Advantage, Coventry Medicare, Aetna, AvMed Medicare plan, AvMed Medicare supplemental plan)

Molina

(participate in Medicare, Medicaid and Exchange/Obamacare plans)

Positive Healthcare*

Preferred Care Partners*

(Preferred Complete Care (HMO), Preferred Choice Dade (HMO-POS), and Preferred Medicare Assist (HMO-POS SNP) 

South Care

Sunshine State Health Plan*

(participate in Medicare, Medicaid and Exchange/Obamacare plans)

 

We accept the following as PCP only if we are listed on card as such.
(If we are specialist, patient needs referral from PCP):

 

Cigna*

(Plans Accepted:  HMO, Open Access Plus, ChoiceFund OA Plus with CareLink, PPO)

Coventry*

(PPO, POS, National, First Health plans.  DON’T take Medicare/Medicaid plans)

Dimension

One Health

Tricare*

 

We accept the following but we MUST be the Primary:

Aetna

(we don't accept Aenta Medicare) 

Humana

Medicare

(We are PCP for Secure Horizons only)

Multiplan

(We accept the PCCC plan)

NHP*

Simply Health Plan/Clear Health Alliance*

UHC

(We accept HMO/PPO/POS/EPO/Choice/Choice Plus plans no referral needed or PCP selection; we don’t accept Medicaid and Medicare Advantage)

 

Health Insurance Exchange Marketplace (Obama Insurance)

 

Cigna LocalPlus

Molina

Ambetter*

 

 

 

*PATIENTS WITH THESE PLANS REQUIRE A REFERRAL FROM PCP IF WE ARE NOT ASSIGNED AS PCP AND SEEING AS SPECIALIST.

 

Patient must check to see if we are included before choosing a plan. Availability of providers is not guaranteed by the insurance carrier and is subject to addition, deletion or change by the insurance carrier at any time without prior notice. Patient must contact their chosen insurance carrier directly for updated information. 

 

If you have questions about your insurance policy and benefits, please refer to your health plan.  If you have questions regarding our billing statement, please contact our billing office at (305) 629-2669.

QUESTIONS ABOUT YOUR BILL

 

Our billing company sends statements on a monthly basis. All balances are due within thirty (30) days of the initial statement date unless prior arrangements have been made.  Garcia MD PA accepts cash, personal checks, VISA, MasterCard and Discover. Credit card payments may be made in person or by telephone.

 

Q: Who should I contact if there are changes in my insurance plan or address?

If you should have changes in your insurance or your address between visits, supply your new insurance card and new address information prior to your next appointment to ensure participation.  If your insurance changes and a bill needs to be sent to a new insurance company, or if your billing address has changed, please contact the office directly at (305) 857-3330.

 

Q: Why am I getting a statement?

A: Multiple Reasons: 

  • Insurance on file is not in effect at time of service

  • We have an incorrect insurance ID #

  • We are not listed as your primary care physician

  • You did not have a referral

  • This is your remaining balance after insurance processed

  • Services were not authorized

  • Procedure or service is not covered by your plan

  • Copay not paid at time of service

  • Incorrect copay amount paid at time of service

 

Q: Why do I still owe a balance if my insurance company paid?

A: Based on your insurance plan, you may be responsible for deductibles, co-pays and co-insurance for fees not covered by your insurance company.

 

Q: Why did my insurance only pay part of my bill?

A: Most insurance plans require you to pay a deductible and/or co-insurance. In addition, you could be responsible for non-covered services. Following your healthcare services, your insurance provider will send you an Explanation of Benefits (EOB), which will detail the amount it has paid, any non-covered or denied amounts, and the remaining balance that you are responsible for paying to Garcia MD PA.  Review this EOB, compare it to your Garcia MD PA billing statement, and call your insurance provider or a Garcia MD PA billing representative at 305-629-2669 if you have questions or concerns.

 

Q: What if my insurance company does not authorize or cover services?

A: You will be responsible for charges your insurance company does not authorize or cover.  Please understand that even though you are expecting insurance to pay for all or part of your medical treatment, you are responsible for your bill. It is wise to familiarize yourself with your insurance benefits. Your health plan mandates that you are financially responsible for payment of all co-pays, deductibles, and non-covered services, and Garcia MD PA is contractually obligated to collect them.

 

Q: Why aren't all services covered by my insurance company?

A: Under any plan, there may be services that are not covered because the insurance company may consider them routine or unnecessary. If you disagree with the decision, you should contact your insurance company for more information.

 

Q: Can I view my Patient Statement (what I owe) on-line?

Subscribers of our HealthTracker patient portal receive an electronic copy of their Patient Statement.

 

Q: Can I make a payment on-line?

The option for online bill payment is coming soon through our online Patient Portal. In the meantime, you may call our office at 305.857.3330 to make a payment over the phone or mail in payment.

 

Q: What if I cannot pay the amount I owe in full?

A: If you are unable to pay your balance in full, we will gladly work with you to develop a reasonable payment plan to help you satisfy the balance on your account. 

 

Q: Why was my last payment divided and applied to the bill in two separate places?

A: We post your payment to the oldest charges first. On your billing statement, we itemize both the charges and your payments by date.

 

Q: What if there is an error on my bill?

A: If you have questions about your bill, or believe that it is incorrect, call our billing office at 305-629-2669.

 

Garcia MD PA

iddocsmiami.com

786.636.6187

Monday -  Friday
Saturday
Sunday

9:00 am - 5:00 pm
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If you are experiencing a medical emergency, please call 911 for immediate medical care.

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