Getting Reimbursed by Insurance

Dr. Fuentes is a board certified internal medicine physician and her services are reimbursable by a typical private medical insurance company. Unlike most large medical groups, she is not under contract with any insurance company directly. This simply means that while a patient can certainly submit a claim to their medical insurance company (and we strongly recommend that they do), the patient is ultimately responsible for the cost of the services provided. The amount of coverage, copay, ect. will depend on the policy of the medical insurance purchased.

After your visit, you will have access to a receipt, which in healthcare is often referred to as a superbill. This contains the information you need to submit a claim. If a medical insurance company would like a copy of the medical note, this can easily be made avaialbe.

This link will download a typical claim form from United Health Insurance. You can likely find an electronic version of a similar claim form on your medical insurance company's website. Since Dr. Fuentes-Valdes is not contracted with insurance companies, your claim submission will be as an "out-of-network"claim. You are welcome to obtain a claim form prior to your visit and fill it out so you can submit for reimbursement right away. The information for the claim for is your information. You are welcome to bring it to the clinic if you have any questions but are responsible for submitting the claim.

Dr. Fuentes-Valdes has opted out of Medicare which means she is not allowed to submit claims to Medicare. There is no "out of network" claims submission process for Medicare as Medicare is a government sponsored program and fundamentally different than private medical insurance.

Please refer to this Medicare link for information about physicians who have opted out of Medicare.

As stated on the Medicare website, it is important to inform those patients subscribed in Medicare that:

• You don't have to sign a private contract. You can always go to another provider who gives services through Medicare. If you sign a private contract with your doctor or other provider, these rules apply:
• You'll have to pay the full amount of whatever this provider charges you for the services you get. You and your provider will set up your own payment terms through the contract.
• If you have a Medicare Supplement Insurance (Medigap) policy, it won't pay anything for the services you get. Call your insurance company before you get the service if you have questions.
• Your provider must tell you if Medicare would pay for the service if you got it from another provider who accepts Medicare.
• Your provider will be able to order and refer to other services which are covered by Medicare such as labs, pharmaceuticals, and referals to Medicare enrolled providers.
• Your provider must tell you if he or she has been excluded from Medicare.
• You can't be asked to sign a private contract for emergency or urgent care.
• You're always welcome to get services Medicare doesn't cover if you choose to pay for a service yourself.

You may want to contact your State Health Insurance Assistance Program (SHIP) to get help before signing a private contract with any doctor or other health care provider.