The following is a brief list of major insurance plans we accept. This list may change without notice or publication. If you do not see your insurance company listed, please contact us at (480) 494-2770 to verify that we accept your particular plan.
- Banner University Care Advantage
- Banner University Family Care
- Blue Cross Blue Shield
- BCBS Medicare Advantage
- BCBS Gilsbar
- Golden Rule
- HealthNet Tricare
- Mercy Care Plan Including Complete Care
- Mercy Care
- Mercy Care Advantage
- Mertain (BCBS Network Only)
- United Healthcare (all plans)
- University Physician Healthcare Advantage
Verifying details of your insurance coverage is ultimately your responsibility. You will be notified during the visit authorization process if you are in-network or out-of-network with Summit Rheumatology.
Please keep in mind that some policies, particularly HMO insurance plans, will require prior authorization or referral. This is typically obtained through your primary care physician or by contacting your insurance carrier directly.
Prior to scheduling telehealth visits, we do ask that our patients verify that telehealth is a covered service with your plan. If this is not a covered benefit, you may be subject to a modified office visit charge.
*If you purchased your insurance through the Healthcare Marketplace Exchange, please verify with your insurance provider that we are in-network prior to scheduling your appointment. Many plans do not have out-of-network benefits, and will not cover our services if we are out-of-network.
Understanding Your Health Insurance
Please refer to common phrases that are used when describing insurance benefits:
Allowed amount – The maximum amount on which payment is based for covered health services
Co-Insurance – Your share of the costs of a covered health service, which is calculated as a percent of the allowed amount for that service. You pay co-insurance plus any deductibles you owe.
Co-payment – A fixed amount you pay for a covered healthcare service, usually paid at the time when you receive the service. This amount can vary by the type of covered health service.
Deductible – The amount you owe for healthcare services that your health insurance plan covers before your plan begins to pay. The deductible may not apply to all services.
Out-of-Pocket Limit – The most you pay during a policy period (typically 1 year) before your health insurance begins to pay 100% of the allowed amount. This limit does not include your premium or health care services that your plan doesn’t cover. Some health insurance plans do not count all of your co-payments, deductibles, co-insurance payments, out-of-network payments or other expenses toward this limit.
Prior Authorizations – Sometimes the services you need require approval or prior authorization by your insurance carrier before the service can be performed. This is common with all specialty pharmacy medications and some procedures or infusion treatments. Authorization for an office visit or telemedicine visit will need to be approved PRIOR to the service and cannot be completed after your visit is complete. We will inform you of prior authorizations that are needed for medications ordered by our office.
Referral – Summit Rheumatology requires valid referrals at the time of each visit. Some insurance plans will authorize several referrals or visits, and others will authorize a referral for each visit individually. Our office will verify that each referral is updated and current for your visit. If your referral is not authorized, you may be asked to reschedule your visit or self-pay for that particular visit depending on the urgency.
Self-Pay – If you do not have health insurance, or elect not to use health insurance for your visit, you are able to qualify for the self-pay or upfront cost of your visit. This will need to be agreed upon before your visit takes place.
Co-payments are collected at time of check-in for each visit. If additional charges are applied to your visit, you will be notified following that visit.