Billing FAQs

What insurance do you accept?  Our office works with most insurance plans, including Cigna, Aetna, Regence, Premera, Meritain, United Healthcare, First Choice, Kaiser Permanente and Medicare.  Please call your insurance to confirm that Dr. Jinwah John Hoy, podiatrist, NPI number 1104820653, is on your insurance plan.

How do insurances commonly work?  There are many different insurance plans.  Most insurances do not pay for all aspects of care, and are increasing cost sharing with the patient in the following ways:

  1. Require a copay for office visits.  The “office visit” is the evaluation and management service with the physician.
  2. Require a referral from your primary care physician.  HMO plans give the patient one primary care physician, and the patient needs to obtain a referral for any specialty care.  You can minimize your out-of-pocket expenses by checking to see if you need a referral to see a specialist, if your current referral is valid, and contacting your primary care physician for a new referral if you need one.
  3. Require satisfaction of a deductible before the insurance kicks in to pay anything.  This deductible can be as high as $6000.  It can apply to a whole visit, or anything outside of the “office visit” described above.  That means any x-rays or procedures are subject to the deductible.  A procedure can include an office surgery such as an injection, biopsy, removing an infection or skin lesion.  You can minimize your out-of-pocket expenses by choosing a plan with no deductible or waiting until your deductible is met before seeking care in this office.
  4. Require a coinsurance after the deductible has been met.  This is a percentage the patient has to pay.
  5. Require a prior authorization, which is an application process for coverage. You can minimize your out-of-pocket expenses by waiting for the prior authorization to be approved before having the procedure performed.

It’s not possible for us to be aware of all the requirements and benefits for each and every insurance plan, only what the insurance company publishes on verification sites.  You are responsible for understanding the terms and conditions of your insurance benefits, as well as keeping up-to-date on changes to your insurance plan.  Please let us know of any insurance changes, or have any questions about your insurance coverage, well before your appointments.  If we are unable to verify your insurance benefits by the time of your appointment, we will not be able to accept your insurance.

Do I need a referral?  If required by your insurance plan to see a specialist, please contact your Primary Care Physician for a referral.

How does the billing work in your office?  Our team is trained, certified and experienced in insurance, billing and coding.  We verify for referral status, eligibility and patient responsibilities and collect at the time of each service.  Please be ready to pay when you arrive for your appointment.

For patients with payment responsibilities, $75 is due for new patients and $25 for established patients before being seen by Dr  Hoy, with the remainder due immediately after treatment is rendered.  Private pay and copays collected are a set amount.  We also collect a deposit at the time of services for certain services that are known to not be covered by insurances, as well as deductibles and coinsurances.  Deductibles, coinsurances and deposits for likely non-covered services are an estimated amount, subject to further billing or credit after submission to insurance.

We will bill your insurance, so you’ll get credit for them. For example, if your insurance has a $5,000 deductible and you have only met $100, and your visit is estimated to cost $200, you’ll be expected to pay that $200 before leaving the office. If after the claim goes through your insurance and the allowable is $205, you will receive additional billing for the $5; if it is $195, you may request a $5 refund.

How much will the visit cost?  Please check this page to learn about how a medical bill is generated.

Do you have payment plans?  Payment plans can be arranged by calling the Billing Department upon receipt of any bill.

Do you protect my information? Our office is PCI-DSS and HIPAA compliant. The Payment Card Industry Data Security Standard (PCI DSS) is a widely accepted set of policies and procedures intended to optimize the security of credit, debit and cash card transactions and protect cardholders against misuse of their personal information. The HIPAA Privacy Rule creates national standards to protect individuals’ medical records and other personal health information.

“Ava and Dr. Hoy were very professional and friendly. My experience was very smooth and stress free. Ava works with your insurance company to figure out your coverage and Dr. Hoy is a bright smiling face. His exams are very thorough and you leave with a solid plan of action!” -Gabrielle A.