Insurance Information

Northwest Medical Specialties accepts most major insurance policies including the following:

• Aetna – all commercial plans
• Cigna/Most Plans
• First Choice Health Network
• Medicare Part B
•  Secure Horizons, Secure Horizons Medicare
• Advantage and Secure Horizons Direct
• Molina
• Premera Blue Cross Blue Shield
• Regence Blue Shield, Regence Selections
• Boeing Selections, Boeing Traditional
• Tricare/Champus
• United Healthcare

Other Insurance policies may also be accepted. Please call (253) 428-8700 for more information.

Insurance Cards

Please bring all of your insurance cards (primary, secondary and tertiary) to every appointment and notify your physician’s office immediately if there are any changes to your insurance. We collect co-payments at the time of service.

Understand Your Plan

Each insurance policy is different, so take the time to understand your plan. The amount of coverage your plan provides varies depending on: your insurance company, your healthcare benefits package and your specific plan. For additional information, contact your plan directly.

To obtain the details of your policy, contact the Customer Service or Member Services Department at your insurance company. The phone numbers are on your insurance card or in your benefits book. They will be able to tell you about your in-network and out-of-network coverage for care and what your financial responsibility will be. Many insurance companies limit payments to medical providers using their own fee schedule of usual, customary and reasonable rates, so ask about this.

Questions to Ask Your Insurance Company

What type of insurance plan do I have?

Your insurance company might tell you that you have one of the following plans:

• Health Maintenance Organizations (HMOs)
• Preferred Provider Organizations (PPOs)
• Exclusive Provider Organizations (EPOs)
• Point of Service (POS) and indemnity insurance plans

Is Northwest Medical Specialties in my network?

If so, here are some follow-up questions to ask:

• Does my insurance plan cover all my physician costs as well as diagnostic testing performed in my physician’s clinic?
• What, if any, are my co-payments?

What if Northwest Medical Specialties is not in my network, but my plan has out-of-network benefits?

If so, here are some follow-up questions to ask:

• If I choose to go out-of-network, what do I have to pay?
• What is the amount of my deductible?
• If I go out-of-network, what percentage of my bill will be paid by the insurance company?(Examples: 80 percent paid by insurance/20 percent paid by patient, 70/30, 50/50, etc.)
• Is the percentage of my bill paid by the insurance company based on usual, customary, and reasonable (UCR) schedules or on the actual charges?
• Does my policy have an out-of-pocket maximum? (This is the maximum amount that you are required to pay toward the cost of your care.)
• If my out-of-pocket expenses reach a certain amount, will the insurance carrier ever reimburse at 100 percent?
• If so, does this mean that my claims will then be paid in full, or will I still be responsible for the difference between Northwest Medical Specialties, PLLC charges and usual, customary, and reasonable (UCR) rates?
• Before I see a doctor with Northwest Medical Specialties, PLLC, do I need a referral from my primary care physician, or will I need authorization from my insurance carrier?
• Will I be covered for any testing, pathology, or radiology charges that may be incurred as part of my care from Northwest Medical Specialties, PLLC?

When speaking with your insurance company sure to make note of the name of the person you talked to and the date you spoke to them.

For more information on what insurance information you will need prior to all appointments please call us at 253-428-8700.