The cost of the visit will vary widely depending on your insurance provider, plan, & deductible. Once a visit is complete, a summary of the visit will be sent to your insurance provider. Your insurance provider will then review the claim, and determine the value of the visit based on their contract with Just 4 Kids Urgent Care.
We do offer affordable self-pay rates that vary with the testing & procedures required. Please call for specific rates. Self-pay rates are generally less than insurance rates when your deductible has not been met.
Health Insurance - Why Is It So Confusing?
Health insurance continues to be one of the most confusing and frustrating parts about health care. We have compiled a simple, brief explanation that will hopefully help you understand how health insurance works.
Every person’s health insurance is different depending on the policy and plan you have purchased. Each company has a variety of plans for you to choose from. These plans offer different co-pays, deductibles, coverage, etc.
If you have not met your deductible, you are likely going to receive a bill that you are responsible for. The amount of the bill is determined by YOUR INSURANCE COMPANY, not the provider or facility you went to.
The provider simply enters codes based on the type of visit and the treatments or tests you had and the insurance company uses those codes to create a price for you based on your plan.
A new patient will have a higher billable amount than a returning patient, for example, but price is determined by your insurance. One plan may determine a price for an x-ray to be different than another plan might. The best way to be prepared is to know where you stand with your deductible and what kind of plan you have.
Another option that you always have is to pay cash for the visit and not send it through insurance. That way, you know your exact expense upfront and you won’t have any surprises. This is a great option for patients with a high deductible plan.
Please do not hesitate to ask our staff if you have any further questions.
Different Codes That Insurance Uses
E&M (Office Visit)
There are two different categories for office visits: new patient and established patient. In each of those categories, there are five different levels. The level depends on the complexity of the visit. Your insurance determines the price from the code we list.
ICD 10 (Diagnosis Code)
These codes are selected by the provider based on the diagnosis they find. This code is used to validate the CPT codes entered.
CPT (Procedures And Supplies)
These codes are entered based on what we did. There are codes for virtually everything from ear wax removal to laceration repair to labs and imaging. Your insurance has its own price that correlates with that code.