Family Doctor CaryNC
Family Doctor CaryNC

FEES/INSURANCE

My typical office visit charges have not changed since 2002. Know your deductible! 

 

Uninsured patients: There is no monthly or yearly fee to be part of our practice. Payment is due in full if we are not contracted with your insurance. 

 

--$150 NEW PATIENT VISIT (A short list of routineLabcorp blood tests are a nominal additional fee) 

--Vaccines/injections and minor surgeries are a standard fee in addition to the $150.

--$88 FOLLOW UP VISIT if you have been seen in the last year

-$135 ESTABLISHED PATIENT NOT SEEN IN THE LAST YEAR OR ANNUAL PHYSICAL

-$135 PEDIATRIC NEW PATIENT VISIT OR CHECKUP

 

---Specialized blood tests for uninsured patients could get very expensive and must be done through an outside lab. 

 

Insured patients: We file the following private insurances (not worker's comp or auto insurance), Medicare and Medicare supplements. The insurance company decides on the amount which is patient responsibility; please look at your EOB from the insurance to understand your bill. Copays and any outstanding balances are due when you come in. Contracted insurances are: Aetna, Blue Cross, Cigna (including Cigna Connect), Coventry, First Health, Medicare, Medcost, United Healthcare, Humana/Choicecare, Tricare, First Medicare Direct (Alignment).

 

If you have CIGNA CONNECT from Healthcare.gov OR Humana Gold plus Medicare HMO, please make sure Dr. Agrawal is designated as your PCP. For Humana, call:Humana Customer Service at - (800) 448-6262.  The PCP # with Humana is – 108962

 

We signed up and credentialed with all the major insurances, but if there is a network of doctors you have to go to, check with your plan first before assuming they will allow you to come this practice. If your card says HMO or POS or if you bought your plan through healthcare.gov, you should make sure we can be designated as your PCP. 

 

 

These are insurances we cannot file unless the companies make a change allowing us to participate:

Aetna Medicare Prime, Aetna DukeSelect, Aetna Duke Basic (all other Aetna and Aetna Medicare  okay)

 

United Healthcare-AARP Medicare - cannot file unless it says "Group PPO" or you are a in a plan from a State Retiree. (all other regular United Healthcare can be filed)

 

We are out of network for Blue Local (all other Blue Cross okay)

 

Medicaid - not credentialed/cannot file  

 

Active duty Tricare members are required to go to an assigned doctor e.g. Tricare Prime

 

FYI: Insurance companies deny claims for certain conditions like insomnia, depression, anxiety, or procedures like joint injections, skin tag removals or benign mole removals. You would receive a bill for these services if your insurance does not deem them medically necessary or covered when done by a family doctor. We will code the visit based on the reason you set up the appointment with the receptionist. 

 

Lab costs - We send your blood and other specimens to Labcorp. They will send you a separate bill. You have the right to know what we are ordering and decide if you want those tests.

We can't predict if your insurance will consider them necessary.

We typically order routine tests and nothing that is extraordinary.

We want to assist you if something was coded/filed incorrectly according to your insurance company when we order labs - please find out specifically what we need to do and we can try to fix it.

We get nothing for ordering labs or tests on you and certainly do not want to run up any bills for you. Again - know your deductible. You will pay all costs except your annual physical and flu shot until that deductible is met. 

 

Medication costs: Many prescriptions normally run about $50-100 these days. If you get to the pharmacy and are shocked that something is $150 or $200, please call us back. We don't know how high prescriptions are priced and we might be shocked as well and be able to change the prescription. If you have a $10 list or low tier 1 drug list, you can bring that to your appointments. Many many many prescriptions need prior authorization by your insurance. We are pretty good at getting that done, but if you call your plan when we hit a roadblock, that helps rather than calling us to see if it's approved. You can even ask them if they will fax us the correct form to obtain prior authorization. 

Family Doctor CaryNC, PLLC
200 Keisler Drive, Suite B

Cary, NC 27518


Phone: (919) 859-7177

Fax: (919) 645-0028

Secure E mail: 

email@familydoctorcarync.com

 

 

 

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