Frequently Asked Insurance Questions

Does NOHN consider my insurance company and benefits when determining who I will see and what care I receive?

NOHN has a separate department that deals with insurance claims. Staff members in that department have no knowledge of clinical decisions, nor do they provide input on providers clinical decisions for your care.

However, our Patient Service Representatives that schedule your appointments and check you in, will acquire as much information as they possibly can to make sure that the provider you will see is within your insurance company’s network.

They will also attempt to acquire your copay amount so that you can take care of it at the time of your visit. Beyond that, your insurance is not a factor in receiving care at North Olympic Healthcare Network.

You will want to make sure that you check your benefits and your insurance company’s network before receiving care anywhere. This is to inform yourself of how much it will cost you out-of-pocket. We WILL NOT turn you down based on your insurance, but we may bill you for the entire cost of your visit.


What financial help does NOHN offer their patients?

Our Community Resource Navigator can help you apply for medical coverage from Washington State, if you are a state resident.

If for some reason you are not covered by health insurance, or your health insurance is inadequate to cover the care  you need, we offer a sliding fee discount for those who need assistance with their bill.

We will also set up payment arrangements with any patient regardless of their financial needs. It requires no financial qualifications. All you have to do is ask to make payments.


Why doesn’t your Dental Office take Medicare

Dental care is not a covered benefit through your standard Medicare Part B. We will gladly see patients that have Medicare insurance; however Medicare will not pay for the services and you will be billed for them.

Beginning in 2020, some Medicare Advantage plans will begin offering a dental benefit. You will be able to see any dental provider that is contracted/credentialed with that insurance. Contact the insurance company to find out what providers are considered in-network.

We also find that many of our patient’s receiving Social Security will qualify for our sliding fee discount program. Please click here for more information on our Sliding Fee Scale.


Can NOHN help patients with costs of prescriptions?

It's quite possible that we can help with the cost of some prescriptions one way or another. The first step is to contact your insurance company to find out how your prescription coverage is structured. Typically, a generic replacement is less expensive than trade name prescriptions.

If you do not have insurance, ask your provider if there is a generic replacement that may be less expensive than what you have been prescribed in the past.

See our Community Resource Navigator who may be able to provide you with ways to reduce the costs of your medications.

If you qualify for our Sliding Fee Program, we will help you out with some prescriptions that are filled at Jim’s Pharmacy according to our contract with them.


I have Medicare. Why does it look like NOHN has billed Medicare for two visits on my statement?

North Olympic Healthcare Network is a “Federally Qualified Health Center” and that second charge you see on your statement is a billing technicality that is enforced for us to maintain this status.

It does NOT mean that you or Medicare is being charged twice. We are only paid by Medicare for services that are considered “FQHC visits”. We are required by Medicare to submit a specific “payment code” that identifies the type of FQHC visit, as well as the charges for the services that were performed within that encounter on our claims.

More information regarding FQHCs can be found by clicking here.

 


When I schedule my preventative care visit, can I discuss my new problems/symptoms or follow-up on other conditions that I’ve had in the past?

If you seek treatment for symptoms or problems you are experiencing today, that is not considered preventative and will not be billed as such. Click here for information about the difference between visit types and the ramifications for your medical costs.

During your preventative care visit, your doctor will review your past medical, social and family history and review your body systems, all with the intent of preventing a future illness. This is a lengthy and IMPORTANT process for which providers want fully-focused time.

Please prepare to make a separate appointment for new problems/symptoms as well as following up on previous diagnoses. This gives providers adequate time to understand your health and the issues you may be experiencing.


Does NOHN require that I scheduled a separate visit for preventative care exam from my follow-up or new problem visit in order to collect more money from my insurance or me?

Absolutely not. Although it is often explained/understood as a “billing” technicality, a Preventative Exam is an important and valuable service that requires your provider to check for several different potential concerns. The preventative visit type is something that was created in order to focus solely on the important work of preventing an illness/condition.

There are many advantages to utilizing this type of visit, especially if it’s a fully covered benefit on your plan. Often, if an illness or condition can be prevented, you and your insurance company, will save an exponential amount of money in the long run. Not to mention the countless non-monetary benefits of preventing illnesses or conditions.

Click here for information about the difference between visit types and the ramifications for your medical costs.


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