Insurance & Fees

Insurance & Fees

The following is the list of insurances with which we participate. This will be updated from time to time as needed:

  • Aetna Commercial/Medicare
    Anthem BCBS
  • Anthem Healthkeepers
    Cigna Healthcare
    Humana
    Humana Military Tricare
    Medicare
    Sentara/Optima Commercial
    Sentara/Optima Medicare
    Tricare
    United Health Care
    Medicare

*Medicaid participation is optional and varies amongst Privia Women’s Health providers – please verify participation prior to your visit.

Note: You should always check with your Privia Women’s Health provider to verify plan and product coverage as this is not an exhaustive list, and plans change frequently.

Frequently Asked Questions

What does in-network vs. out-of-network mean?

In-network
Insurance covers most of the services fees if we are in-network with your plan. Your plan benefits will feature the following elements, where applicable.

Co-insurance: Percentage of the fee you pay, with the rest paid by your insurance plan, after any deductible is met.

Out-of-pocket limit: The most you have to pay for covered services in a plan year. After you spend this amount, your insurance plan will pay all remaining fees.

Deductible: Total dollar amount you must spend before your insurance pays for non-preventive services.

Co-pay: Fixed amount you pay per visit.

Out-of-network
Your insurance may cover a portion of services fees, depending on your insurance plan benefits.

Out-of-network benefits: A percentage that your insurance plan promises to pay for out-of-network services. Often, this percentage ranges from 50-80%, if your out-of-network benefits apply.

Out-of-network deductible: Amount you must pay for out-of-network services before your insurance will begin to pay you back for any portion of the costs.

Transparent, affordable prices
No surprises — We’ve got you covered with simple service fees and out-of-pocket cost estimates. We also make self-pay seamless with market-based prices set with affordability and sustainability in mind.

Type of Care In-network Out-of-network Self-pay
Preventive $0 $45-125 $175-245
Physical Therapy $0-150 $100-250 $100-250
Follow-Up $15-25 $20-85 $85-165
Same Day $15-25 $40-75 $75-145
Specialty $30-50 $30-125 $15-233
Lab Fees Varies Varies $15-100

 

What insurance plans are you in-network with?

We’re in network with plans from all major insurance carriers, including Medicare. However, some plans, even from major carriers, restrict access to providers like EvoScient Gyn. Even if you see your insurance plan listed on our site, you should confirm with your insurer through their find a doctor tool.

If we’re not in network with your plan, have no fear! We strive to offer affordable and transparent cash options for individuals who are unable to use an insurance benefit. Email patientcare@evoscientgyn.com if you’d like a quote.

What are co-pays?

A co-pay is a fixed amount the patient pays for medical services. The remaining balance is covered by the patient’s insurance company. Co-pays may vary within the same plans, depending on the service provided. If you have a co-pay, we’ll attempt to collect it prior to your departure. However, sometimes we do not become aware of a co-pay until we’ve billed your insurance carrier, in which case, we may reach out requesting payment.

What is a deductible?

A deductible is a fixed amount a patient must pay each year before their health insurance benefits begin to cover the costs. After your deductible has been met, patients typically pay coinsurance — a percentage of the total costs — for any services that are covered by the plan. They continue to pay the coinsurance until they meet their out-of-pocket maximum for the year.

How much will I pay for care at EvoScient Gyn?

The amount you’ll owe depends on the type of visit you’re here for, as well as the specifics of your insurance plan. Please reach out to your insurance carrier if you need help understanding your benefit design. If you have a high deductible health plan, we are happy to provide you with a cost estimate for your care if you email us at patientcare@evoscientgyn.com.

Is my annual wellness visit / physical free?

Usually. However, some insurance plans only cover one annual wellness visit per year. So before scheduling your visit, if you’ve already had an annual wellness visit or physical this year, confirm with your health insurance company whether you’re allowed to have a second. We won’t know ourselves whether you’ve used up your allowance – if you have one – until we bill your insurance company.

Can I pay with a flex spending card?

Yes. As a reminder, make sure you have your current card information and be aware that your Flex spending fund expires at the end of each calendar year.

Can I pay with an HSA?

You can pay for a wide range of IRS-qualified medical expenses with your HSA, including many that aren’t typically fully covered by health insurance plans. This includes office visits, prescription, and travel vaccines.

What is the refund policy

In the event you are owed a refund due to overpayment, that refund will be returned to your original credit card, or will be available as a credit for future visits.

How can I pay my bill?

You can pay your bill in one of three ways. In-person, after your visit or before your next visit. Via phone, if you call us directly. Or through the patient portal, where we can send you a payable invoice.

How do I read my insurance card?

Your identifying information

Your health insurance card usually has your name on it. If you have insurance through someone else, such as a parent, you might see that person’s name on the card instead. The card might also include other information, such as your home address, but this depends on the insurance company.

Policy number

Insurance cards will have a policy number, usually on the front of the card. Each health insurance policy has an associated policy number. On your card, it is often marked “Policy ID” or “Policy #.” The insurance company uses this number to keep track of your medical bills.

Group plan number

If you have health insurance through employer, your insurance card probably has a group plan number. The insurance company uses this number to identify your employer’s health insurance policy. As an employee, you are covered by that policy. Not all insurance cards have a group plan number.

Insurance company contact information

The bottom or back of your health insurance card usually has contact information for the insurance company, such as an address, phone number, and website. This information is important when you need to check your benefits or get other information. For example, you might need to call to check your benefits for a specific treatment, contact your insurance company, or find information on the website.

Coverage amounts, in and out of network, and co-pays

The “coverage amount” tells you how much of your treatment costs the insurance company will pay. This information might be on the front of your insurance card. It is usually listed by percent, such as 10%, 25%, or 50%. You might see several percent amounts listed together. For example, if you see 4 different percent amounts, they could be for office visits, specialty care, urgent care, and emergency room care.

In network and out of network

You might see another list with 2 different percent amounts. The first percent, which is normally larger, shows how much the insurance company pays doctors and other health care providers who are considered “in network.” “In network” means that the insurance company has an agreement with this group of providers. The second percent amount is the amount your insurance company pays doctors and other health care providers who are “out of network.” Your insurance company does not have an agreement with providers who are outside the insurance company’s network. You are allowed to see providers who are “out of network,” but you will have to pay them more than you would to a provider who is “in network.” When you see any health care provider, you will have to pay the amount that the insurance company does not cover. To find out if a provider is “in network” contact your insurance company.

Co-pays

Finally, you might see a dollar amount, such as $10 or $25. This is usually the amount of your co-payment, or “co-pay.” A co-pay is a set amount you pay for a certain type of care or medicine. Some health insurance plans do not have co-pays, but many do. If you see several dollar amounts, they might be for different types of care, such as office visits, specialty care, urgent care, and emergency room care. If you see 2 different amounts, you might have different co-pays for doctors in your insurance company’s network and outside the network.

Prescription coverage

Your health insurance company might pay for some or all the cost of prescription medicines. If so, you might see an Rx symbol on your health insurance card. But not all cards have this symbol, even if your health insurance pays for prescriptions. Look at your own card for an Rx symbol. Sometimes, the Rx symbol has dollar or percent amounts next to it, showing what you or your insurance company will pay for prescriptions. If you are not sure whether your health insurance pays for prescriptions or how much it pays, call the number on your insurance card to find out.

Payment Options

We accept cash, Visa, Mastercard, Discover, American Express, and personal checks.

Card-on-File

We encourage patients to keep a credit card on file to make the checkout process easier, faster, and more efficient. You will no longer receive statements from us, but you will continue to receive your Explanation of Benefits (EOB) from your insurance carrier once your claim has been processed, detailing the charges and payments made on your behalf.

At check-in we will:

  • scan the credit card of your choice, including your Flexible Spending Account (FSA) or Health Savings Account (HSA) card

After your insurance has paid their portion, we will:

  • notify you via email of the balance owed
  • charge the balance owed to your card on file
  • email a receipt for the charge

Your credit card information will always be fully protected by our off-site, card-processing partner Elavon, and not on our computers, as required by industry standards (Payment Card Industry Data Security Standard – PCI-DSS).

Fees

No Shows
Missed Physical $100
Late Cancellation $50
No-Show $50
Missed Procedure $200
Out-Of-Network
New Patients Total Charge or Minimum $200 Deposit
Established Patients Total Charge or Minimum $150 Deposit
Self-Pay
New Patients Total Charge or Minimum $200 Deposit
Established Patients Total Charge or Minimum $150 Deposit
Procedures Total Charge or Minimum $200 Deposit

Additional Resources

Avoiding Surprises in Your Medical Bills

Avoiding Surprises in Your Medical Bills (Spanish)

Understanding Healthcare Prices: A Consumer Guide

Understanding Healthcare Prices: A Consumer Guide (Spanish)

Planning For a Medical Procedure