Medical Insurance and Navigation

The best care

Miriam Medical Clinics recognizes that healthcare insurance can be a challenge to understand. 

The many options of care, payment plans, referral patterns, pre-authorization for medicine, x-rays and other tests can be confusing. 

 

What are the Basics?

 

  • Do you have healthcare insurance?  Is your plan an HMO or a PPO, Medicare or Medicaid?

  • Do you have a primary care physician?  If your plan is an HMO, did you have a primary care physician assigned to you?  If you have an HMO, the name and phone number of your primary care physician will be printed on your card?.

  • Do you have a co-pay or deductible for visits? 

  • Is the co-pay or deductible higher if you see a doctor outside of your insurance network? Check with your insurance company to determine if a medical provider is in your network in order to avoid higher costs?

  • Can you see the specialists you need?

  • Does your primary doctor have to give you a referral to see a specialist? All policies are different, check with your insurance carrier if you are in doubt.

  • Can you get medical supplies and equipment?  The doctor will need to provide you with a prescription for medical supplies and equipment. Payment for allowable medical equipment and supplies are different for each insurance company.  The insurance company bases their decision on your policy type, your diagnosis, and medical necessity.  There is a process for your doctor to get authorization for approved supplies.

  • Are you eligible for Medicare or Medicaid? Medicare is available for senior citizens 65 and over?  It is also available for the disabled, and citizens with certain chronic illnesses.  Medicaid eligibility is generally income based, but it too can be provided to citizens with a limited number of chronic illnesses.  For both Medicare and Medicaid, it is best contact the state department of social service or the federal social security department to see if you qualify.

  • What if you have no insurance at all? Call Miriam Medical Clinics, we do not require patients to have insurance to be seen.  There might be a minimal charge for your visit for certain services, but our goal is to meet your health care needs despite your ability to pay.

 

All these questions can be answered relatively simply.   Most importantly, if you have health care insurance, you should  have a primary care physician.  The company will provide you with the list of doctors and their phone numbers upon your request.  These can be had either by calling the number on your insurance card or accessing the information online. 

 

If you have questions about how to navigate the health care insurance, call Miriam Medical Clinics at 215-644-8745.  We want to help make it easy to stay healthy.

If you have medicare or medicaid, you can access information directly from this website:

medicare.gov