Payment & Insurance Information

Payments for all office visits, laboratory testing and other procedures are due in full at the time of service unless other arrangements have been made in advance.


Health Insurance Coverage for Services at the Center

The Carolina Center does not contract with insurance companies, including Medicare/Medicaid/Tricare.  Moreover, although many of our services have been covered by insurance in the past, we can provide no assurance or guarantee that you will receive insurance reimbursement for any of the charges at the Center.  As a courtesy, these charges will be filed with your insurance company if it is determined that you have out-of-network benefits, and you will receive reimbursement from the Center when appropriate.  The main exception is Blue Cross Blue Shield (BCBS), which will not reimburse for services, regardless of whether you have out-of-network benefit status.  In addition, the Carolina Center will not provide BCBS any records for the purpose of insurance determination if requested by the insurance company or the patient.  Finally, the Center has “opted out” of the Medicare program, and Medicare will not reimburse for any fees paid to the Center or the patient.

In summary, your ability to receive insurance reimbursement for any of the charges at the Carolina Center will depend on the specific policies of your insurance carrier.  With the exception of BCBS and Medicare, many insurance carriers are increasingly willing to provide coverage for integrative medicine, recognizing its emphasis on health promotion and disease prevention (which ultimately translates into lower health care costs over time).  If you are among those millions of Americans who cannot afford health insurance, we will work with you, as much as possible, to accommodate your budgetary constraints, and we will plan strategically to minimize costs while hopefully meeting your treatment and health-related goals.


HEALTH INSURANCE INFORMATION

How the Carolina Center Handles Insurance Claims – Our Policy

The Carolina Center is an Out-Of-Network provider and is not contracted with any insurance companies, including Medicare, Medicaid or Tricare.  Moreover, although many of our services have been covered by some insurance plans in the past, we can provide no assurance or guarantee that you will receive insurance reimbursement for any of the charges at the Center.  Over the years, we have determined in general which insurance companies typically pay better for these out-of-network services, therefore as a courtesy, if you have a plan with one of these better companies, we will file these charges on your behalf.  You are still responsible for payment of your out-of-network deductible which is due at the time of service but overall we have found that this system provides our patients with some coverage by these select companies which improved their ability to undergo a more extensive work-up and range of treatments at a lower out-of-pocket cost. 

As with all other doctor’s offices, we ask patients to provide their insurance information prior to their initial visit so we can contact the company and determine ones benefits which help us to better advise patients in terms of the scope of the investigation and treatment we may recommend.  This information should be updated at each office visit and whenever insurance plans change.  From this information we will look at the following information to help us make the determination as to whether we can file for services:

 1. CARRIER - Based on one’s insurance carrier, a determination can be made whether or not the Carolina Center can file for any services provided to include labs, office visits and procedures.  While this list isn’t complete, from our experience, we have made the following determinations:  

Insurance carriers for whom the Carolina Center can file claims (GOOD COVERAGE):

i.       Cigna
ii.      United Health Care
iii.     Wellpath
iv.     Aetna – we can only file office visits, no other procedures or labs
v.      Inclusive Health


Insurance carriers for whom the Carolina Center can NOT file claims (POOR COVERAGE):

i.      Blue Cross Blue Shield (the exception are those therapies for which there is prior approval

ii.     Great West - administered by Cigna but won’t pay.  

iii.    GEHA

iv.    Medicare

v.    Medicaid

vi.     Tricare

2. OUT OF NETWORK BENEFITS – The next most important aspect of determining if anything can be covered, we must determine if their plan provides for out of network coverage at all.  Some patients will have good companies but no out-of-network coverage so it is essentially useless. 

 3. DEDUCTIBLE - The deductible must also be considered as some people will have what is considered “catastrophic” coverage with very high deductibles.  These are being phased out with the Affordable Care Act but still exist.  If a patient has one of the plans for which we can file and requests that we do so, we will require payment for whatever portion remains of the out-of-network deductible. 

4. CO-INSURANCE – Most insurance will require a 20% co-pay for in-network services and 40% for out-of-network.  Others have more or less generous co-pays.  We do not typically collect this co-insurance at the time of service due to being unable to easily calculate what it would be until processed but patients may be billed for some portion of this co-insurance after payment is received from the insurance company. 

5. DATE - It is also important, especially as one approaches the latter part of the year, to look at the effective date of the policy – essentially the date the deductible starts over.  If someone is close to this date and still has a lot of deductible to meet, it may be appropriate to do a minimal work-up now and then do everything else once the date resets.   Effective dates are most commonly January 1st but they frequently are also July 1st and September 1st

6. OTHER FACTORS – It is important to remember that many individuals have Health Care Savings accounts or other types of Flex plans through their employer with this money being available to cover expenses that insurance won’t as well as cover their deductible.  

7. NO INSURANCE – For those individuals who have had no healthcare insurance possibly due to pre-existing conditions or being unaffordable, it is now possible to obtain comprehensive healthcare coverage through the Affordable Care Act at www.healthcare.gov.  Unfortunately, the choices available to NC Citizens are extremely limited with none of these being identified as providing out-of-network coverage for our services, but can be used for in-network lab testing.  We urge anyone who has no health insurance to take advantage of this opportunity to obtain this coverage. 


 In summary, your ability to receive insurance reimbursement for any of the charges at the Carolina Center will depend on the specific policies of your insurance carrier.  With the exception of those companies mentioned above, many insurance carriers are increasingly willing to provide coverage for integrative medicine, recognizing its emphasis on health promotion and disease prevention (which ultimately translates into lower health care costs over time).  If you are among those millions of Americans who cannot afford health insurance, we will work with you, as much as possible, to accommodate your budgetary constraints, and we will plan strategically to minimize costs while hopefully meeting your treatment and health-related goals.  Ultimately however we strongly recommend you obtain insurance through the Affordable Care Act (ACA) so a greater portion of your expenses will be covered. 

At the time of each office visit, our staff will determine if out-of-network benefits are available for each patient.  If such benefits are available, we will file the charges on your behalf.  A partial payment of 80% of the total bill is required at the time of service.  Any payments received from your insurance company will first be applied to any balance due, after which you may receive a refund, be billed for a balance, or owe nothing.


Filing for Laboratory Testing

As noted above for those patients we determine have out-of-network coverage with carriers with whom we have had good experience with payment and the plan has a reasonable deductible that is likely to be met quickly, the Carolina Center will submit claims for all services rendered to the carrier in an attempt to receive payment.  In the case of laboratory testing, the Carolina Center will file for these charges and not request payment in advance, other than whatever out-of-network deductible is still owed. 

The Carolina Center can only estimate insurance payments based on past experience and communications with various insurance carriers.  Based on these estimated calculations after receipt of the deductible from the patient and other fees and payment to the Carolina Center by the insurance carrier, it may be determined that the patient owes a balance if the insurance carrier considered certain tests to be non-covered.  We will inform all patients of the maximum amount possibly owed in the event the insurance payment and payments prior to testing do not adequately cover costs of these tests. 

Be aware that any payments made directly to the patient by the insurance company for the services filed by the Carolina Center is owed to the Carolina Center and must be paid immediately.  The Carolina Center will apply any insurance payments reimbursed to remaining amounts due for non-reimbursed charges.  If there is a credit from the insurance reimbursement, Carolina Center will credit the patients account for funds due.  If there is a credit after these applications, this amount will be itemized and reimbursed within 30 days, unless one is on an ongoing treatment plan at the Center, in which case the Center will retain these funds to be applied to these services.  Patients have the right to request these credited funds be reimbursed and upon written request, these will be provided within 30 days.