General Insurance Information

In the “new age” of managed care, knowing how and when to contact your insurer seems almost more important than knowing how to contact your physicians.

Know Your HMO

A doctor’s participation status may change at any time without notice, and insurers’ rules change frequently without notice. Therefore it is critically important that you:

  • Check with your insurance carrier for updated provider participation information.
  • Know and follow the “fine print” in your contract. Please be certain you have read and fully understand all of the material your insurer has supplied you.
  • Let us know your HMO or insurance status at the time of your visit. This is because each HMO or insurance coverage has different rules about which doctors you can be referred to, which laboratories or x-ray services we can use, which tests we can do in the office, and which services are covered. Not knowing often leads to problems and upset for both you and us.

Insurance Cards & Co-Pays

The following are health plan requirements and regulations that we must legally follow:

  • Your current, valid health plan identification card must be presented at the time of each and every visit. Your card serves as your “credit card” for medical services in our office.
  • A co-pay generally is required for each and every patient's encounter, no matter how brief the encounter.
  • Co-pays must be paid at the time of the visit. When a family insists that their co-pay be billed, a (non insurance covered) billing fee (currently $10.00) must be added to the account.

We have found that the most common causes of coverage problems are:

  1. Patients not having or not presenting their valid, personal HMO or insurance card at each and every visit
  2. Patients not informing our office of changes in their insurance coverage as soon as they take effect
  3. One of our physicians not being listed as the primary care physician with the insurer and on the card
  4. Not getting appropriate referrals to specialists prior to visiting them (or trying to get a referral prior to one of our doctors evaluating the problem in the office)
  5. Not repeatedly reminding everyone involved in their care about their insurance coverage

These five reasons account for nearly all of the coverage denials which then become the patient’s financial responsibility – and therefore lead to a great deal of frustration.

Essex Office One Wildwood Medical Center
35 Saybrook Road
Essex, CT 06426
Tel: 860.767.0168

8:30 am to 5:00 pm M-F
8:30 am to noon Saturday

Ped-I-Care After Hours Care
Available in Our Essex

6:00 pm to 8:00 pm M-F
Noon to 5:00 pm Saturday
11:00 am to 4:00 pm Sunday & Holidays

Old Saybrook Office 30 Elm Street
Old Saybrook, CT 06475
Tel: 860.388.4545

8:30 am to 5:00 pm M-F

NCQA Recognized