Insurance & Billing Information
| Insurance | Status |
|---|---|
| AARP | In network |
| Allegiance | In network |
| AMCO | In network |
| Aetna / US Healthcare – non HMO | Out of Network |
| Aetna Senior Supplemental Insurance | In network | Allied Benefit Systems | Out of Network | AmeriHealth Administrators | In network |
| American Insurance Admin | Out of Network |
| American Postal Workers Union | In network |
| American Progressive | In network |
| American Republic | In network |
| Amerigroup – Americaid | Out of Network |
| BCBS-FL | In network |
| Anthem Mediblue Access PPO | Out of Network |
| BCBS-FL HMO | Out of Network |
| Bankers Life & Casualty | In network |
| Care Improvement Plus | Out of Network |
| Central States H&W&P Fund | In network |
| Champus Tricare For Life | Out of Network |
| Champus Tricare North/Sout | Out of Network |
| Champva | Out of Network |
| Choice Workers Comp | In network Lee County only |
| Cigna | In network |
| Cigna Supplemental Insurance | In network |
| Commercial Travelers | Out of Network |
| Connecticare | In network |
| Fallon Health Plan | Out of Network |
| Central States H&W&P Fund | In network |
| Champus Tricare For Life | Out of Network |
| Champus Tricare North/Sout | Out of Network |
| Champus Tricare West | Out of Network |
| Champva | Out of Network |
| Cigna | In network |
| Cigna Supplemental Insurance | In network |
| Commercial Travelers | Out of Network |
| Connecticare | In network |
| Fallon Health Plan | Out of Network |
| First Health Network | In network |
| Florida Health Care Plan | In network |
| Freedom Healt | Out of Network |
| GEHA | In network |
| GHI PPO | Out of Network |
| Global Medical Management | In network |
| HealthPartners | In network |
| HealthSmart Preferred | In network |
| Healthcare Partners IPA | Out of Network |
| HealthyCT | In network |
| Heritage | In network Lee County only |
| Humana Commercial | In network |
| Humana MCR | Out of Network |
| MMSI – Mayo Mgnt Svc Inc | In network |
| MVP (Mohawk Valley Plan) | In network |
| MagnaCare | Out of Network |
| Medica | In network |
| Medicaid | Out of Network |
| Medical Mutual of Ohio | In network |
| Medicare DME | In network |
| Medicare PIN | In network |
| Medico Insurance Company | In network |
| Meritain Health | In network |
| Molina Healthcare of FL | Out of Network |
| Mutual of Omaha | In network |
| Multiplan/PHCS | In Network |
| National Preferred Provider Network aka Plan Vista | In Network |
| Oxford | In network |
| Prestige Health Choice | Out of Network |
| Priority Health | In network |
| Railroad Medicare-Palmetto | In network |
| State Farm Insurance | Out of Network |
| SummaCare | In network |
| Sunshine State Health Plan | Out of Network |
| Tufts | In network |
| UPMC Health Plan | Out of Network |
| US Dept of Labor-Workers Comp | In network |
| Unicare | In network |
| United American Ins | In network |
| United Healthcare PPO | In network |
| United Healthcare – The Empire Plan | In network |
| United Healthcare Community Plan PPO | In network |
| United Healthcare Life Ins PPO | In network |
| United Healthcare Student Resources PPO | In network |
| United Healthcare West PPO | In network |
| United Healthcare of River Valley PPO | In network |
| United Medical Resources PPO | In network |
| UnitedHealth-One PPO | In network |
| Univera Healthcare | In network |
| Veterans Affairs-Federal | In network |
| Web TPA | In network Lee County only |
| Wellcare | In network |
| Wellmed | In network |
| Wisconsin Physicians Services | In network |
| WorkCare | In Network |
| Worker’s Compesation | In network |
| Worker’ Comp NCH employyes | Out of Network |
Message from Dr. Kevin Lam
Dear Patients of FFLC:
I realize that medical billing is very complex and our staff is here to help you navigate through this maze. 3rd party insurance carriers often pit the doctor against the patient and vice versa.
Please be patient with us as we make interaction with out billing department more streamlined. You may leave a query through our patient self service line above, or email billing@naplespodiatrist.com
Please do not send any personal information through unsecured email. We will help to answer any questions, etc as from personal experience, it is confusing even as a doctor being on the patient side.
We do have rules that we must abide by: If we are in network, we have to accept the contracted rate.
Example: If medicare allows $90 for the visit, the doctor can bill out $300 he / she will just get the $90.
Medicare only covers 80% of the allowable charges, the other 20% either goes to patient responsibility or to their secondary insurance as an example.
Common liners from insurance companies
- Your doctor just has to call this 800 number to get prior authorization
- Reality: Doctors or staff will call this number, be put through a hoop then sent forms to fill out for something we already wrote and rx for, this is a way to discourage utilization.
- Reality: They will have another doctor on the other line, whose job is to find ways to deny services or medications
- Reality: If your doctor writes a script is because he /she wants you to have the test or medication, prior authorizations are a deterrent and delay to such
- Have your doctor send the correct code, we will pay for it.
- Certain services are not covered by insurance such as RadioFrequency Ablation for neuromas, high or low energy shockwave therapy. These cash services are not covered by insurance but to “pass the buck”, sure have your doctor send in the right / correct code, even though none exists.
- Currently July 2018 codes for the above do not exist, in fact insurance companies have policies against payment for those above treatments, but yet tell the patient on the phone to have your doctor submit the right / correct codes.
Not covered by one of the above insurance plans? Please contact your insurance carrier about adding Family Foot and Leg Center as a preferred provider for excellence in Lower Extremity care. Family Foot and Leg Center will offer affordable payment solutions for healthcare services rendered, specifically for minor surgical procedures that otherwise might be unaffordable to the uninsured. Payment is due in full at the time of service. All tools will be provided so that your insurance can reimburse the patient/member directly.
Regarding Humana Medicare Advantage PPO
We will be OUT OF NETWORK with this insurance company come Sept 1, 2011 due to their unilateral decision we have this letter on file for anyone to see. Patients can still see us as out of network providers. We will keep the fee schedules intact as they are a Medicare plan, you may have a higher deductible or copay so please refer to your manual or call your sales representative in regards to your OUT OF NETWORK BENEFITS. At FFLC, we did not terminate the Humana contract, Humana decided to do such on their own thus shrinking the size of the in network providers. From a provider and patient advocate standpoint, traditional medicare with a supplement such as AARP provides the patient with more choices and less paperwork. Please do reconsider when it is time to renew your Medicare Advantage Plan.
United HealthCare Plan Status
| EMPLOYER INDIVIDUAL PRODUCT | Status | |
|---|---|---|
| Charter EPO | Participant | |
| Charter HMO/HMO Plus | Participant | |
| Charter POS | Participant | |
| Choice EPO | Participant | |
| Choice Plus HMO | Participant | |
| Choice Plus POS | Participant | |
| Compass EPO | Participant | |
| Compass Exclusion | Non- Participant | |
| Compass HMO/HMO Plus | Participant | |
| Compass POS | Participant | |
| Core EPO | Participant | |
| Core HMO | Participant | |
| Indemnity | Non- Participant | |
| Navigate EPO | Participant | |
| Navigate HMO/HMO Plus | Participant | |
| Navigate POS | Participant | |
| NexusACO NR EPO | Participant | |
| NexusACO NR HMO | Participant | |
| NexusACO NR POS | Participant | |
| NexusACO OA POS | Participant | |
| NexusACO R EPO | Participant | |
| NexusACO R HMO | Participant | |
| NexusACO R POS | Participant | |
| NexusACO OA EPO | Participant | |
| NexusACO OA HMO | Participant | |
| NHP Direct Access | Non- Participant | |
| NHP Gated – L1 | Non- Participant | |
| NHP Gated – L3 | Non- Participant | |
| NHP Gated HMO | Non- Participant | |
| NHP Out of Service Area | Non- Participant | |
| PPO | Participant | |
| Select EPO | Participant | |
| Select Plus HMO | Participant | |
| Select Plus POS | Participant | |
| UHC Core Choice Plus | Participant |
Community State Product
| EMPLOYER INDIVIDUAL PRODUCT | Status | |
|---|---|---|
| Bayside Pediatrics | Non- Participant | |
| CAIDSFPN | Non- Participant | |
| Evercare at Home (EAH) /Medicaid LTC | Non- Participant | |
| FL DSNP | Participant | |
| FL Medicaid | Non- Participant | |
| FL Medicaid Comprehensive | Non- Participant | |
| FLA Doctors Medical Center, MCAID | Non- Participant | |
| FLA MCAID Network Healthmed Group, Inc. |
Non- Participant | |
| Florida Chip | Non- Participant | |
| Florida HealthyKids Corp | Non- Participant | |
| Florida LongTerm | Non- Participant | |
| Health & Home Connections (HHC) Miami/Medicaid LTC |
Non- Participant | |
| Ideal Medical Centers | Non- Participant | |
| MedCaid American Care Inc | Non- Participant | |
| Medicaid (RAM) | Non- Participant | |
| Medicaid Health Choice Network | Non- Participant | |
| Medicaid Health Network One | Non- Participant | |
| Medicaid IPA’s | Non- Participant | |
| Medicaid Manatee Co Rural Health Sys | Non- Participant | |
| Medicaid MCCI | Non- Participant | |
| Medicaid MDHC | Non- Participant | |
| Medicaid Ped Associates | Non- Participant | |
| Medicaid Physicians Access Group | Non- Participant | |
| Medicaid SFL Ped Partners | Non- Participant | |
| Medicaid Tampa Community Healthcare | Non- Participant | |
| Medicaid Tampa Region | Non- Participant | |
| Personal Care Plus | Non- Participant | |
| South Florida Medical Centers | Non- Participant |
Medicare Retirement Product Collier County
| EMPLOYER INDIVIDUAL PRODUCT | Status | |
|---|---|---|
| AARP MedicareComplete Choice PPO | Participant | |
| AARP MedicareComplete Choice Essential Regional PPO | Participant | |
| AARP MedicareComplete Choice Plan 2 | Participant | |
| AARP MedicareComplete Plan 2 HMO | Participant | |
| UnitedHealthCare Assisted Living Plan PPO SNP | Participant | |
| UnitedHealthCare Group Medicare Advantage HMO |
Participant | |
| UnitedHealthCare Group Medicare Advantage PPO | Participant | |
| UnitedHealthCare Nursing Home Plan PPO SNP | Participant |
Medicare Retirement Product Lee County
| EMPLOYER INDIVIDUAL PRODUCT | Status | |
|---|---|---|
| AARP MedicareComplete HMO | Participant | |
| AARP MedicareComplete Choice PPO | Participant | |
| AARP MedicareComplete Choice Essential Regional PPO | Participant | |
| AARP Medicare Complete Choice Plan 2 | Participant | |
| AARP MedicareComplete Plan 2 HMO | Participant | |
| UnitedHealthCare Assisted Living Plan PPO SNP | Participant | |
| UnitedHealthCare Group Medicare Advantage HMO | Participant | |
| UnitedHealthCare Group Medicare Advantage PPO |
Participant | |
| UnitedHealthCare Nursing Home Plan PPO SNP | Participant |