Insurance and out of pocket costs at our practice, explained

Healthcare cost transparency is hard, especially in women's health. Here is a plain language guide to what's typically covered, what isn't, and how to avoid surprise bills.

What insurance we accept

Most major plans, including: Aetna, BlueCross BlueShield, Cigna, United Healthcare, Horizon NJ Health, Oscar, Medicare, and most NJ Medicaid plans. If you don't see your specific plan, call us at (973) 782 5577 with your card and we will check coverage before your visit.

What's usually covered by insurance

Under the Affordable Care Act, most insurance plans cover several preventive women's health services at no cost to the patient (no copay, no deductible) when in network:

• Annual well woman visit
• Pap test and HPV testing at recommended intervals
• Mammograms starting at age 40
• Most FDA approved contraception, including IUDs and implants and their placement
• STI screening and counseling
• Breastfeeding support and supplies
• Domestic violence screening

Source: healthcare.gov, "Preventive care for women" (current ACA preventive coverage rules).

What might be billed separately

A few things are common sources of surprise bills:

• Lab work. Pap tests, cultures, blood work, and pathology may be processed by an outside lab that bills separately. The visit itself can be free; the lab can still send a bill.
• Pelvic ultrasound. Considered diagnostic, not preventive, so a copay or coinsurance may apply.
• Procedures. Colposcopy, LEEP, IUD removal between covered intervals, and biopsy are typically billed.
• Anything outside annual screening guidelines. For example, an extra Pap test before the next recommended one.
• Discussion of a problem during a preventive visit. If your annual turns into a workup for a specific symptom, you may be billed for an additional office visit.

How to avoid surprises

• Call your insurance and ask whether the visit you're scheduling is covered as preventive or diagnostic.
• If you have a deductible, ask whether it applies.
• For procedures, ask for a written estimate before the procedure.
• When labs are sent out, ask which lab will be used and whether it's in your insurance network.
• If you receive a bill that seems wrong, call our office first. We can often resubmit or correct coding.

If you're uninsured or self pay

We will share self pay rates before any visit so you can decide. We also help with NJ FamilyCare (Medicaid) enrollment screening when relevant.

Questions about your specific situation?

Call us at (973) 782 5577 with your insurance card and the type of visit you need. We'll tell you what we know upfront.

Or request an appointment and a member of our team will follow up by the next business day.

This article is educational only and does not replace personal medical advice. For questions about your situation, please contact our office or call (973) 782 5577.