Insurance (PPO plans only)

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We accept:

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• Anthem Blue Cross PPO (Established Patients Only)

• Aetna PPO and POS

• Blue Shield of California PPO

• Cigna PPO and EPO (Open Access Plus)

• Cigna + Oscar PPO

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Common Insurance Terminology

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1. Co-pays
This is a set amount you pay for a specific service, like a doctor’s visit or a prescription. For example, your co-pay might be $20 for a regular office visit. You pay this every time you receive that service, regardless of your deductible.

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2. Deductibles
Your deductible is the amount you need to pay out-of-pocket for covered services before your insurance starts helping with the costs. For instance, if your deductible is $2,000, you’ll pay 100% of your medical bills until you’ve spent $2,000. After that, your insurance kicks in to share the costs.

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3. Co-insurance
Once you’ve met your deductible, co-insurance is the percentage of the bill you’re still responsible for. For example, if your insurance covers 80%, your co-insurance is 20%. So, for a $100 bill, you’d pay $20, and your insurance would pay $80.

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4. Out-of-Pocket Maximum
This is the most you’ll have to pay in a year for covered medical expenses, including your deductible, co-pays, and co-insurance. After you hit this limit, your insurance pays 100% of covered costs for the rest of the year.

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Example to Tie It All Together:

Let’s say you have:

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• A $1,500 deductible

• 20% co-insurance

• A $5,000 out-of-pocket maximum

 

If you visit the doctor for a $150 bill, you pay it entirely until you’ve reached your $1,500 deductible. After that, for a $200 bill, you’d pay 20% ($40), and insurance covers the rest. Once you’ve paid $5,000 total out-of-pocket in a year, your insurance will cover everything else for that year.

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Health insurance can feel confusing, but knowing these terms can make it easier to plan for your healthcare costs. If you ever have questions, we’re here to help!​​

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Out Of Network Plans

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If we do not currently accept your insurance, you may still spend less at our office if you have a high-deductible health plan, because you would still use your insurance for blood tests or prescriptions, etc. Our services are payable with funds from Flexible Spending Accounts (FSAs) or Healthcare Savings Accounts (HSAs).

 

If Dr. Hennessay is "out-of-network," you can still be seen at our clinic if you have a PPO plan! You will be provided with a superbill to submit to your insurance company and, depending on your insurance, you may be reimbursed for some of the care received out-of-network, or credited toward your deductible (or both).  Dr. Hennessay will help you submit your insurance claim form. 

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It may also be more cost-effective to have a few cash-based office visits, rather than going to the ER or urgent cares, depending on your PPO deductible/copay structure.

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If Uninsured

It is better to invest in regular visits to the doctor, with the goal of avoiding complications later in life. If you are living with chronic medical conditions, it is even more important to access care regularly. We keep our rates affordable to allow access to high-quality medical services, so that even if you cannot afford the expense of health insurance, we hope to put an office visit within reach.

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What happens if you are uninsured and need to be hospitalized?

To prevent catastrophic out-of-pocket costs, if you are uninsured, it is recommended to have a type of coverage plan that would cover you in the event of an emergency. You can get catastrophic coverage through the health insurance exchange. Health for California insurance brokers are a trusted resource to help you find a plan that fits your needs.