We are preferred providers for Premera and Regence PPO plans only { and as of Dec 2017, most but not all of them :(. They keep changing the rules...} FOR ALL OTHER INSURANCES, PAYMENT IS DUE AT THE TIME OF THE APPOINTMENT - cash, check or charge card. We will supply you with a detailed billing statement which you can submit to your insurance company to request reimbursement. IT IS BEST FOR YOU TO CHECK WITH YOUR HEALTH INSURANCE TO BE SURE OUR CLINICIANS ARE ON THEIR PROVIDER PANEL. THEY CHANGE THE PANELS SOMETIMES, BUT THEY DON'T TELL US FIRST :( . You may certainly continue to see us for your ADHD care, but it may be on a cash basis, you submit the charges to your insurance for out-of-network benefits.
For Regence Blue Shield Dr. Pomeroy is contracted as a "preferred provider" on the PPO plans only. If you have the Selections plan we are NOT a preferred provider; you may come in as a cash pay patient.
PREMERA and REGENCE
Billings for patients with Premera and Regence will be submitted directly to them; co-pays are due at the time of service in line with requirements in our contracts and yours with these insurances. Any "co-insurance" or percentage of the allowable amount you are responsible for, will be billed to you after notice to us from Premera or Regence. If your policy has a "deductible" that must be met before the plan pays for your visits, until that amount has been met charges for the visit are payable at the time of the visit.
As of December 2017 some of their plans and "preferred provider" panels changed, and we were excluded from the panels. Not our choice!! We don't want you to have any surprised about charges not being paid by your insurance; it's not fair to you nor to our office. CHECK WITH THEM FIRST IF YOU HAVE RECEIVED ANY NOTICE FROM YOUR INSURANCE ABOUT CHANGES.
If there is any reason for us to believe that services we provide may not be covered by Premera or Regence, for example, by contract exclusions (some plans do not cover mental health visits for instance), we may ask you to sign a Waiver which states that in the event that Premera or Regence does not cover our services to you on that given date you agree to be responsible for them.
MEDICARE
We are not Medicare providers, Dr. Pomeroy has "opted out" of Medicare. Our office cannot, by law, submit bills to Medicare and neither can patients ask for reimbursement from Medicare for visits made to our office.
Medicare requires that physicians who do not see patients under the Medicare system sign a contract with Medicare "opting out" of the system. This is an agreement not to bill Medicare for any services.
Patients who have Medicare coverage must agree not to submit bills to Medicare for any services from ADD Center of Bellevue. All patients with Medicare must sign a specific notice of this information, per Medicare regulations. If Medicare is your primary coverage with a supplemental insurer, this policy applies. If you have "Part B" coverage with Medicare, for hospital care, and have a separate private primary coverage, the policies above for insurances applies.
MEDICAID and Labor & Industries
ADD Center of Bellevue does not have contract agreements with either WA State Medicaid or Dept of Labor & Industries, so we are unable to bill them for services. If you have "medical coupons" or an active L&I claim, we cannot accept them as payment, so payment will need to be made at the time of service.
ADD Center of Bellevue does not accept a (pending) injury claim as method of payment for services. If you believe your condition may be related to an injury from an accident, or from a stroke, you should obtain care from a neurologist or a Brain Injury center or clinic. We do not provide the extent of evaluation and diagnostic services needed to fully evaluate possible brain injuries.
AETNA, UNITED, CIGNA, etc
WE HAVE CONTRACTS ONLY WITH PREMERA AND REGENCE HEALTH PLANS.
Due to the high overhead costs of dealing with other insurers, we are unable to contract with them. This means we are "out of network" for all other health insurance plans. You will need to pay visit charges at the time of service if you have health insurance other than Premera or Regence. We will give you a receipt and billing information in the format required by insurers so you can file for reimbursement from your carrier.