We are contracted with most insurance carriers, PPO's, Medicare, as well as Medicaid.
If you don't see your insurance carrier on our insurance and billing section, please give us or your health insurance plan
provider a call to double check. The number can be found on your plan card. Service and benefit
coverage vary based on geographic location.
To get your specific copay cost amount for your visit, we'll need to see your insurance card and
verify the insurance carrier. We recommend that you call the member's services number on the back of your insurance card
and ask about coverage and co-payment fees for urgent care visits. Co-pays for an urgent care visit will
typically be different than the co-pay amount for a primary care visit. If you don't have time to call your insurance,
we can determine the co-pay amount if your plan and coverage is verified upon check-in to your visit.
A co-pay, short for copayment, is a fixed amount a healthcare beneficiary pays for covered medical services.
The remaining balance is covered by the patient's insurance company. Co-pays typically vary for different services within the same plans,
particularly when they involve services that are considered essential or routine and others that are considered to be less routine or in the
domain of a specialist. Co-pays for standard doctor visits are typically lower than those for specialists.
Note that copays for emergency room visits tend to be the highest. A deductible is a fixed amount a patient must pay each year before
their health insurance benefits begin to cover the costs. After meeting a deductible, beneficiaries
typically pay coinsurance—a certain percentage of costs—for any services that are covered by the plan.
They continue to pay the coinsurance until they meet their out-of-pocket maximum for the year.
Co-pays and deductibles are just two parts of the health insurance equation.
In general, plans that charge lower monthly premiums have higher co-payments and higher deductibles.
Plans that charge higher monthly premiums have lower co-payments and lower deductibles.
We have real-time insurance eligibility; however, there may be times when an
insurance plan can't be verified due to the following: The Payer ID not being accurate,
The insurance plan is from a third party, The insurance provider eligibility system is not responding
If your insurance was verified upon your clinic visit,
Prognify bills your insurance about three days after your appointment.
If you have outside lab work done you will be billed completely separately by LabCorp or Quest.
If the lab and test is performed entirely within our clinic it will appear on your Prognify bill.
Your insurance may pay all or portion of your bill, depending on your benefit plan and your deductible.
At some point you will receive an EOB (Explanation of Benefits) from your insurance, directly.
This is not your bill but an explanation of what insurance paid/covered and what you may owe.
You can always check the status of your bill in your patient portal on the Prognify website by
tapping your profile in the lower right then "Bills". You can track Due, Paid and Sent/Waiting.
For a full breakdown you can tap the information (i) icon next to the appointment date.
If you have any patient responsibility once your claim has been processed by your insurance,
you will receive an invoice via email from email@example.com and an SMS alert when your bill is ready.
You can pay securely and instantly by tapping Pay Now in the email. You can also pay directly in the app.
Please contact us at firstname.lastname@example.org if it's been more than two months since your appointment
and you still have not received a bill, or if you have any billing questions at all. Happy to help!