Insurance Accepted at TPMG

Tidewater Physicians Multispecialty Group (TPMG) contracts with the following insurance carriers as an organization. However, please note, not all TPMG physicians actively participate in the following list of carrier plans; therefore, to avoid unexpected or additional out-of-pocket expense, contact your physician’s office to verify that they participate with your insurance plan.

Commercial Insurance

Anthem (PPO)
     – Including Anthem Healthkeepers Plus & Anthem Medicare Advantage
Aetna (PPO1)
Cigna
GEHA/United Healthcare Shared Services
Optima (PPO, POS, HMO)
     – Optima Family Care
     – Optima Selects Plan
     – Optima Fit
Virginia Health Network (A MedCost Company)
United Healthcare (HMO, PPO, Choice)

Medicare

Anthem Keepers (PPO)
Anthem Medicare Advantage
Humana Medicare

Medicaid

Anthem Keepers Plus CCC+
Optima CCC+

TRICARE

Tricare For Life
Tricare Prime
Tricare Standard

If you have questions regarding your insurance, please contact your insurance company.

For questions regarding your bill, please contact our Central Billing Office at (757) 232-8777.


Financial Policy

We are dedicated to providing the best possible care for you, and we want you to completely understand our financial policies.

Co-payments, deductibles and non-covered fees are the responsibility of the patient. They are due at the time of service.

Please understand that your insurance policy is a contract between you and your insurance company. We cannot assume that any specific charge will be covered. Your involvement in knowing what your plan covers is important and we encourage you to become familiar with your plan. This information is best obtained by contacting your insurance company. Please bring your active insurance card to each visit.

Co-payments, deductibles and coinsurance are part of the contractual agreement between you and your insurance company. Your insurance company requires us to collect your co-payment in full at the time of service. If your plan also has a deductible and/or coinsurance that hasn’t been met, we will collect a deposit of $100.00, as we can only estimate the future amount due, at the time of service.

If Tidewater Physicians Multispecialty Group, P.C. (doing business as TPMG) is not part of your health insurance company’s network, then some health care services you receive from TPMG may not be provided by an in-network provider. We recommend that you contact your health insurance company to determine if TPMG is an in-network provider. If not, you may be billed and financially responsible for health care services performed by us as an out-of network provider, in addition to any cost-sharing requirements that you may have.

We file primary and secondary insurance claims for our patients. In the event of a third insurance, claims are expected to be filed by the patient. If a service is considered “not covered” by your insurance company, the patient will be responsible for the uncovered balance. If you do not agree with the denial, you must resolve the matter with your insurance company. Payment is due upon receipt of a statement from our billing office. Failure to do so may result in any balance being forwarded to a contracted collection agency and potential dismissal from the practice.

If a referral is needed, notification must be made at least 48 hours before the appointment. If you have a medical situation after hours which may require a referral, please contact the doctor on-call to help direct you.

If, for any reason, you are unable to keep your appointment, please contact our office to reschedule or cancel at least 24 hours in advance. Failure to call to cancel an appointment without sufficient notice may result in a charge to your account. This fee is not covered by any medical insurance. If you miss two or more appointments without calling to reschedule or cancel, you may be dismissed from the practice.


Common Insurance Terms:

Co-payment – a fixed dollar amount you pay for a covered health care service, usually at the time of service. Co-pays do not count toward your deductible.

Co-insurance – The percentage of costs of a covered health care service you pay after you have paid your deductible.

Deductible – The dollar amount you must pay out-of-pocket during the year for medical services before your insurance company begins to pay for any services.

Out-of-Pocket Maximum – The most you have to pay for covered health care services, including deductible, copayments and coinsurance, in a plan year.

Formulary – A list of prescription drugs, both generic and brand name, covered by an insurance plan.

Prescription Drug – A medication that, by law, requires a prescription to be dispensed.

Primary Care Physician (PCP) – The particular doctor you select to be your main doctor to monitor your overall health.