Understanding Insurance and Rates

  • Benefits – Medical expenses that your health insurance policy covers

  • Co-Insurance – The percentage of covered expenses you share with your insurance company. For example, let's say your health insurance plan's allowed amount for an office visit is $100 and your coinsurance is 20%. If you've paid your deductible: You pay 20% of $100, or $20.

  • Co-pay or Co-payment – A fixed amount for a covered service, paid by a patient to the provider of service before receiving the service. It may be defined in an insurance policy and paid by an insured person each time a medical service is accessed

  • Deductible – A deductible is the amount you pay each year for most eligible medical services or medications before your health plan begins to share in the cost of covered services. For example, if you have a $2,000 yearly deductible, you'll need to pay the first $2,000 of your total eligible medical costs before your plan helps to pay.

  • Exclusions – Medical and other expenses that your health insurance policy does not cover

The maximum dollar amount an insurance company will pay for a given procedure or service. If a provider has a contract with an insurance company, the provider and the insurance company negotiate an allowed amount for each service or procedure. If a provider has a contract with a health insurance company, then the health insurance company considers the provider in-network and will not charge more than the allowed amount for a given procedure.

  • This list is not complete.  Additional rates will be added as contracts are completed and not all services are listed and priced.

  • Rates can vary depending upon the credentials of your provider and if additional services are deemed medically necessary during the appointment, example urine screens and psychotherapy.

  • Self Pay   New Patient $300,  Follow up  $100-$120

  • Anthem PPO and HMO  New Patient $140,  Follow up $100

  • Anthem Pathway & Pathway X  New Patient $140,  Follow up $96.40

  • Aetna Commercial  New Patient $156.48,  Follow up $100

  • United Behavioral Health Plans OPTUM  New Patient $167.90,  Follow ups $100

  • Cigna Behavioral Healthcare $149.11  Follow ups $79.48

  • Humana

  • Optima

  • Medicare (100% rate if deductible isn't met)  $160.22,  Follow up $100

  • We are not contracted with all insurance plans, please contact our billing department before your appointment with insurance changes.

                                                                     billing@avewellwalnut.com

Virginia Medicaid Plans

Virginia Medicaid

 Virginia Premier 

 Optima

 Anthem Healthkeepers

  Aetna Better Health of Virginia

 Magellan Complete Care of Virginia.

 United Health Care Community Plan.

Medicare Palmetto GPA and Railroad

Commercial Plans

Anthem PPO, HMO, Pathways and Advantage

Aetna Commercial PPO, POS, EPO, HMO

(not all plans; in the process of contracting Aetna Medicare

Cigna Behavioral Healthcare (not all Cigna plans. Currently plans beginning with a U.)

Optum; United Behavioral Healthcare

(MAHP HMO network,MAHP HMO network, MAMSI One Net PPO

Mamsi PPO,Medicaid,Medicare,Oscar HeALTH PLAN

Va DSNP Dual Service,Va Commonwealth Coordinated Care Plus VA CCP

Va Medallion Medicaid

Optima Behavioral Health

Humana Choice Care PPO, Choice Care Point of Service POS, Choice Care PPO, Choice Care Plus Network PPO, National POS Option PPO, National POS Option Access Plus

(We currently are out of network with all Humana HMO and Gold plans.)