Insurance and Billing

Our services are covered by most insurance companies. Unfortunately our specialty, Osteopathic Manipulative Treatment, has been subjected to nationwide audits and unsubstantiated refunds for services. After being subjected to this multiple times, we made the very difficult choice to phase out of in-house insurance billing. At this time we are only billing Samaritan Choice, LifeWise, Regence Blue Cross Blue Shield and Pacific Source. We are out-of-network with all other health insurance companies, including Medicare and Medicaid.

If you utilize an insurance company we do NOT bill, we will collect payment from you directly on the date of service and you may bill your insurance company for reimbursement. We will provide all the documentation and guide you through the process. (See below for steps regarding reimbursement)

To facilitate this transition, we adjusted our pricing to soften the financial transactions. The amount that is reimbursed to each patient for our services will vary based on the individual policies and coverage. The out-of-pocket cost to you is generally a little higher for an out-of-network provider; however in some cases (after deductibles and our rate adjustments) the out-of-pocket is lower. We recommend you call your insurance company and ask them. We have composed a form to help you get the information you need from your insurance company, see link below.

Download form as: PDF

Patient Insurance Billing

Most insurance companies are very quick to pay their patient’s out-of-pocket claims. There may even be the ability to fax or email your reimbursement claim for faster response. Many insurance companies have online user-friendly question and answer websites. If convenient, you could try finding the information there.

Here are the steps to get reimbursed from your insurance company (in no particular order):

  • Some insurance companies have a “reimbursement” form; you should inquire about their steps for reimbursement ahead of time. Often just sending these items will work:
  • A sales receipt that states you paid in full and need to be reimbursed directly (which Crossroads Premiere Health Care will provide on the day of your appointment.)
  • A form with the date of service, procedure and diagnosis (es) code(s) for the services you received (which you will also receive on the day of your appointment.)
  • Your personal information including name, date of birth, age, address, phone number insurance ID number, group number, and a Prior Authorization number if one has been issued.
  • Submit to the address specified by your insurance company.

Note: Until you have actually billed and received a check from your insurance company, you will not know for certain how much you will be reimbursed!

Medicare Patients

Unfortunately we are a non-preferred provider with Medicare, which means our services are not covered and Medicare will not allow you to bill for reimbursement. You would have to pay for our services entirely out-of-pocket. Further, Medicare requires us to have you sign a waiver that you understand this policy. However, some supplemental policies may pay for Medicare’s non-covered items. You should call and ask.

In Closing…

If any information provided here contradicts your personal experience, please advise us so we can correct it. If you have any additional questions or need assistance, feel free to contact Bridgett in our office at 541-207-3772 or email at crossroadsphc@gmail.com.