Frequently Asked Insurance Questions
Yes, we do. Referrals are no longer needed for Medicaid patients to visit an urgent care. If the visit is URGENT, such as a possible broken bone, laceration, head injury, difficulty breathing, or allergic reaction, no referral was ever needed. However, non-urgent visits, such as ear infection, sore throat, low-grade fever, etc. no longer require a referral. What does that mean? Come see us if you need us – no referral needed.
The cost of the visit will vary widely depending on your insurance provider, plan, & deductible. Once a visit is complete, a summary of the visit will be sent to your insurance provider. Your insurance provider will then review the claim, and determine the value of the visit based on their contract with Just 4 Kids Urgent Care.
We do offer affordable self-pay rates that vary with the testing & procedures required. Please call for specific rates. Self-pay rates are generally less than insurance rates when your deductible has not been met.
As a service to our patients, we will gladly bill any insurance provider. Currently, we are contracted (in-network) with:
- Blue Cross
- Blue Shield
- Bridgespan Health
- Deseret Mutual Benefit Administrators (DMBA)
- Eastern Idaho IPA
- Health Net Federal Services (Tri-Care)
- Idaho Physician Network
- Mountain Health Co-op
- Pacific Source
- Regence Blue Shield
- Select Health
- United Healthcare
Please contact your insurance provider directly for specific questions related to your coverage, deductible, & plan.
No, we do not. If you opt to take advantage of our pre-authorization program, then your card information is kept with our billing office, until the amount is charged to the card, then it is removed from the account. We do not ever have access to your card information here in our office.
No. We will gladly bill your out-of-state Medicaid, but our experience has been that they generally do not cover out-of-state visits. We suggest contacting them directly to confirm your coverage. We do offer affordable self-pay rates as another option.
Health Insurance - Why is it confusing?
Health insurance continues to be one of the most confusing and frustrating parts about health care. We have compiled a simple, brief explanation that will hopefully help you understand how health insurance works.
Every person’s health insurance is different depending on the policy and plan you have purchased. Each company has a variety of plans for you to choose from. These plans offer different co-pays, deductibles, coverage, etc.
If you have not met your deductible, you are likely going to receive a bill that you are responsible for. The amount of the bill is determined by YOUR INSURANCE COMPANY, not the provider or facility you went to.
The provider simply enters codes based on the type of visit and the treatments or tests you had and the insurance company uses those codes to create a price for you based on your plan.
A new patient will have a higher billable amount than a returning patient, for example, but price is determined by your insurance. One plan may determine a price for an x-ray to be different than another plan might. The best way to be prepared is to know where you stand with your deductible and what kind of plan you have.
Please do not hesitate to ask our staff if you have any further questions.
Different Codes that Insurance Uses
E&M (Office Visit)
There are two different categories for office visits: new patient and established patient. In each of those categories, there are five different levels. The level depends on the complexity of the visit. Your insurance determines the price from the code we list.
ICD 10 (Diagnosis Code)
These codes are selected by the provider based on the diagnosis they find. This code is used to validate the CPT codes entered.
CPT (Procedures And Supplies)
These codes are entered based on what we did. There are codes for virtually everything from ear wax removal to laceration repair to labs and imaging. Your insurance has its own price that correlates with that code.