Insurance Information

Co-insurance

The amount plan members pay out-of-pocket for medical services. The payments usually constitute a fixed percentage of the total cost of a medical service covered by the plan; for example, if a plan pays 80 percent of a health bill, the patient pays the remaining 20 percent as co-insurance.

Deductible

The sum of money that an individual must pay out-of-pocket for medical services before the health plan pays its portion. Deductibles are usually per person, or per family, per calendar year; for example, an individual may have a $200 deductible whereas a family may have a $400 deductible.

Our staff also will call your insurance company in advance of your procedure to get an estimate of how much you will be asked to pay. Please remember this is just an estimate. The final amount due will be determined after your insurance company processes your claim.

Here are things you should know about coverage and fees:

Precertification

Many insurance companies require that you contact a representative before a procedure, sometimes even in an emergency. Check your insurance card for special instructions about precertification or preauthorization. If your insurance company requires a preauthorization, we will work with your referring physician to obtain this; however, you should always verify that the authorization, if required, has been obtained. This will help ensure your claim will be paid in a correct and timely manner.

These guidelines explain how we may process your claims:

Health insurance plans:

In most cases, we will bill your primary health insurance company. If we haven’t heard from your insurer after 30 to 45 days, we may ask for your help in contacting a representative. Amounts that are denied, rejected or left unpaid may become your responsibility, depending on your plan type and benefits. Getting preauthorization from your insurer can help you find healthcare providers in your plan's network and locations that offer services covered by your plan. Preauthorization is not a guarantee of coverage. Ask about your plan's limits and eligibility before you seek service.

Medicare

We will submit your claim and then bill unpaid amounts through supplemental insurance policies, if you have these. Unpaid balances may become your responsibility, depending on your plans and benefits.

Medicaid:

Call in advance to verify coverage. We will bill in accordance with your plan’s policies. If we are not listed as a provider with your Medicaid product, you may be responsible for the balance.

Workers’ compensation:

If a bill is related to treatment for an injury or accident at work, we will file a claim with your employer’s workers’ compensation insurance carrier. Get authorization before scheduling services, when possible. Claims that are denied may ultimately become your responsibility.

Options if you are uninsured:

For your convenience, we accept most forms of payment, including cash and checks, VISA, MasterCard, American Express and Discover credit cards. Payment plans can sometimes be arranged in accordance with our policy.

DRI has a self-pay fee schedule for our uninsured patients, so they can receive services. Self-paying is a term used to describe someone who chooses to pay for their treatment directly.

If you want to self-pay for treatment then, first, you need to be referred by your physician. We will then work with you and share the fee for your needed treatment at our self-pay rates and make payment arrangements.

Health insurance card checklist

We understand your health insurance authorization can be a tedious process. To ensure you have an easy transition, we are providing you with a checklist of preparations that simplify the entire experience; this minimizes surprises while your insurance provider processes your medical claims.

Beyond your name and policy number, your insurance card contains important information. Many insurance companies list special instructions on the card about pre-certification or prior authorization for services.
Check your card. If it shows that you must call your insurance company for authorization, ensure that you or a member of your family calls the company immediately. You usually must do so within 24 hours.

To meet your insurance requirements, ask yourself...

• Have you read the information on the front and back of all of your, and your spouse's, insurance cards?
• If you are required to get pre-certification or authorization for services, have you called your insurance company?
• If you've called your insurance company, have you given the hospital your authorization number?
• Do you know if your insurance company will cover doctor and hospital charges?
• If your policy has a deductible, how much is it?
• If your policy requires a second medical opinion, have you received it?
• If your policy requires a co-payment, how much is it?
• If your policy requires a referral form for health services, have you received it and given it to the hospital's admissions office?
• If your policy requires a claim form, have you filled it out?
• If you are scheduled for surgery, is it related to an accident? If so, have you given the hospital all information about when, where and how the accident happened?
• Are you covered by more than one insurance plan? If so, have you given the hospital all the information about all plans, including the plan name, address, phone number, ID number, enrollee's date of birth, completed claim form and/or completed referral form?

We do not want you to be surprised by anything, so we offer as much information regarding your health insurance as possible to assist in understanding your financial responsibility. If you have further questions, contact DRI.

Insurance plans

We are in network with many health insurances plans nationwide. Refer to the insurance plans listed below to see if your DRI provider participates with your health insurance plan. Contact us if you do not see your insurance plan listed.

• Health insurance acceptance
  • AARP Medicare Complete (UHC)
  • Aetna
  • Alliance PPO
  • America’s First Choice
  • BCBS Wells Fargo (WFU)
  • BCBS PPO
  • BCBSNC State
  • BCBSNC Federal
  • Bind (part of UHC)
  • Blue Medicare
  • Bright Health
  • BMI (School insurance)
  • Carolina Steel
  • Champus/Tricare (not Tricare Prime)
  • Cigna
  • Cigna Health spring
  • Workers Comp
  • Coventry Health/ First Health
  • FirstHealth (some plans)
  • Gateway Health
  • Genex
  • Humana (Medicare products)
  • Inclusive Health (NC Health Risk Pool)
  • Medcost
  • Medicaid (North Carolina only)
  • Medicaid Healthy Blue
  • Medicaid Carolina Complete
  • Medicaid AmeriHealth
  • Medicaid UHC Comm Plan
  • Medicaid WellCare
  • Meritain Health
  • Medicare
  • Medicare Advantage Plans/Managed Care products (follow mcr free schedule) 
  • NYSHIP UHC
  • Prime Health
  • Pace
  • Railroad Medicare
  • Secure Horizons
  • UMR
  • United Healthcare