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At Novomed Centers, we chose to work closely with insurance providers. By doing so, we can align our priorities with yours: returning you to optimal health with minimum out of pocket expenses.
However, certain services are not covered by insurance, such as allergy tests that can identify what you are allergic to before starting on a desensitization program to eliminate the allergy instead of resorting to prescribed medication.
Most insurance companies do not cover bariatric or obesity procedures that can reverse diabetes and high blood pressure once and for all.
An increasing number of patients are looking for an alternative to the fragmented care model by visiting our naturopathic or integrative medicine doctors that do not rush to prescribe a pill for every ill. Again, their services are not covered by insurance, although we try whenever possible to have our GP order some of the lab tests that are covered by insurance whenever possible.
Many expensive tests like CT scans, MRI’s and mammograms and all elective surgeries require pre-approval by the insurance company. Our efficient team does a good job at communicating with your insurance company. Our track record of quality, honest dealings, including the avoidance of unnecessary tests or surgeries, are recognized by insurance companies, which facilitates speedier approvals.
If your insurance policy has out-of-network benefits, a portion of our charges may be covered. Before your first visit, talk to your insurance company or to our patient support team about your out-of-network benefits and what they include, as every plan is different.
To help our patients file accurate claims for reimbursement, we provide detailed billing forms containing all of the appropriate codes to submit to your insurance plan. For those who would like us to submit the claims on their behalf, we are happy to do so.
More information is provided below in the FAQ’s, or you can call our office to discuss in detail with our patient coordinator on 042473100.
If you are in doubt what tests are covered by your policy, please refer to your insurance provider.
Ask your insurance company to provide you with the answers to the following 4 questions:
“What is the maximum amount of out-of-pocket expenses I will be required to pay annually?”.
The Novomed team assists in filing a “clean” claim with your insurance provider, meaning we ensure that the claim is correctly coded.
We also submit the form in the layout preferred by your insurer, so that it will be processed faster and more accurately.
Claims denied for contract limitations are not the responsibility of Novomed. The claims which are denied in error due to poor insurance company adjudication practices are also not the responsibility of Novomed.
These claims must be appealed by a telephone request for redetermination or by written appeal. Please be sure to file your appeal within the timeframe given by your insurance provider; otherwise, you may lose your right to appeal.
Please be sure to document the following:
If your employer provides you insurance cover and you find your claims are being denied repeatedly, you should report the problem to your company’s Human Resources Department, so they can intervene on your behalf. Otherwise, you should consider finding a new insurance provider.
Entering this information manually allows room for error for example, we have noticed that insurance company claim processors frequently code the diagnoses checked off on your fee slip from left to right, instead of properly connecting each diagnosis code with its corresponding treatment code. Without logical procedure code/diagnosis pairings, your claim will result in automatic rejection of your claim.
On the other hand, when Novomed files your claim, we do so in your insurance provider’s preferred format electronically. Treatment and diagnostic codes are correctly matched and ranked. These claim forms are almost always electronically “read” and automatically processed. The result is that most of the claims we process reach a decision quickly therefore payment is processed quicker.
The non-prescription nutritional supplements that are available for purchase at Novomed’s pharmacy are not covered under your insurance company’s prescription plan. However, you can apply for reimbursement depending on your insurance policy.
Please mention the need of the prescription to your physician during your appointment, prior to purchase. The copy of your prescription must be submitted with your reimbursement request.
Networks : EN, CN, GN
Penta 1 & 2
Platinum, Gold & Silver network
Platinum & Gold
FMC Gold Network
FMC Premium Network
FMC Firstcare Farid GN Plus
FMC Firstcare Farid GN-1
FMC Firstcare Farid GN-2