Insurance InformaTIon
General Insurance Information
NWMS accepts most major Insurance policies.
Aetna – all commercial plans
Cigna/Cigna FlexCare
First Choice
First Health
Great West Healthcare
Medicare
Medicare Private Fee for Service (PFFS) plans
PacifiCare Commercial, PPO, Secure Horizons, Secure Horizons Medicare Advantage and Secure Horizons Direct
Molina
Premera Blue Cross Blue Shield
Private Health Care Systems
Regence Blue Shield, Regence PEBB, Regence Selections, Boeing Selections Plan, Boeing Traditional Medical Plan, Regence Medicare Advantage PPO Plan, all commercial plans
Tricare/Champus
Uniform Medical Plan
United Healthcare
Other Insurance policies may also be accepted. Call 253-428-8700 for more information.
Please bring your insurance card to every appointment, and immediately notify your physician’s office of any changes in your insurance. Co-payments are collected at time of service.
Each insurance policy is different, so take the time to understand your plan. The amount of coverage your plan provides varies depending on:
- Your insurance company
- Your healthcare benefits package
- Your specific policy
To obtain the details of your policy, contact the Customer Service or Member Services Department at your insurance company. The phone numbers are on your insurance card or in your benefits book. They will be able to tell you about your in-network and out-of-network coverage for care and what your financial responsibility will be. Many insurance companies limit payments to medical providers using their own fee schedule of usual, customary and reasonable rates, so ask about this.
What type of insurance plan do I have?
Your insurance company might tell you that you have one of the following plans: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), Point of Service (POS) and indemnity insurance plans.
Is Northwest Medical Specialties, PLLC in my network?
If so, here are some follow-up questions to ask:
Does my insurance plan cover all my physician costs as well as diagnostic testing performed in my physician’s clinic?
What, if any, are my co-payments?
Northwest Medical Specialties, PLLC is not in my network, but my plan has out-of-network benefits.
If I choose to go out-of-network, what do I have to pay?
What is the amount of my deductible?
If I go out-of-network, what percentage of my bill will be paid by the insurance company? (Examples: 80 percent paid by insurance/20 percent paid by patient, 70/30, 50/50, etc.)
Is the percentage of my bill paid by the insurance company based on usual, customary, and reasonable (UCR) schedules or on the actual charges?
Does my policy have an out-of-pocket maximum? (This is the maximum amount that you are required to pay toward the cost of your care.)
If my out-of-pocket expenses reach a certain amount, will the insurance carrier ever reimburse at 100 percent?
If so, does this mean that my claims will then be paid in full, or will I still be responsible for the difference between Northwest Medical Specialties, PLLC charges and usual, customary, and reasonable (UCR) rates?
Before I see a doctor with Northwest Medical Specialties, PLLC, do I need a referral from my primary care physician, or will I need authorization from my insurance carrier?
Will I be covered for any testing, pathology, or radiology charges that may be incurred as part of my care from Northwest Medical Specialties, PLLC?
Note: Be sure to make note of the name of the person who gave you talked to and the date you spoke to them.
Financial consulting services are available at no charge to all patients attending NWMS clinics.
