Tidewater Allergy and Asthma accepts most major insurance providers, but we encourage all patients to contact their insurance company to confirm that we are in-network with their specific plan.

 

Additionally, we encourage all patients to contact their insurance company to verify specific allergy and immunology benefits.  While the office visit, breathing tests, and allergy testing are covered benefits under most plans, the amount insurance companies require patients to pay (the patient responsibility) will vary considerably even among plans of the same insurance company. 

 

As the provider, the insurance company is not required to give us any information about what a visit may cost prior to an appointment. Therefore, it is difficult for us to determine exactly what portion of the bill insurance will require the patient to pay (the patient responsibility) until the insurance reviews our claim and sends us the explanation of benefits (EOB) after the visit.

 

We work hard to review insurance information prior to your visit; however, it is ultimately the patient's responsibility to confirm coverage and benefit amounts before their visit.  

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Prior to your initial visit, please call your insurance company to verify benefits. 

Below is a list of information you may need:

• Your insurance card (the phone number to your insurance co. is usually found on the back)

• Name and DOB of the policy holder

• Name of your provider: Dr. Jeremy Owens, MD or Christina Barnett, FNP-C

• Location: either our Virginia Beach or Chesapeake Location

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Below is a list of questions to ask your insurance company when you call:

1. Do I need a referral for allergy and immunology services?

2. Do I have allergy and immunotherapy benefits? If so, what are they?

3. Do I have any riders on my policy for allergies or asthma?

4. If I were to have pulmonary function testing (lung function testing), would it be covered?

   • Ask about 94375 (standard PFT) and 94060 (PFT with albuterol)

5. If I were to have allergy testing, would it be covered?

   • Ask about codes 95004 (prick test/subcutaneous allergy test) and 95024 (intradermal/intracutaneous allergy test)

   • For skin testing, you are billed by the method of testing (e.g., Prick (Percutaneous) and/or Intradermal (Intracutaneous)) and by the number of substances that are tested.

6. If I were to have Allergen Immunotherapy (allergy shots), would it be covered?

   • Ask about codes 95165 (allergen immunotherapy serum vials) & 95117 (allergy injections)

7. Will any of my services need prior authorization?

8. What will be my patient responsibility (cost) for office visits? For testing? For AIT?

9. Do I have a copay or coinsurance? Do I have to meet my deductible before this applies?

10. Do I have to meet a deductible on any office procedures?

 

If you would like to request an estimate and have us reach out to your insurance company, please request one in the patient portal. We are happy to partner with you!

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Partnering with families and educating patients is at the heart of everything we do here at Tidewater Allergy and Asthma.  With that, here's a little dictionary of insurance terms that may be helpful when you call:

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• Coinsurance:  A percentage of the cost of a covered healthcare service that you pay after you have met your deductible. For example, if your coinsurance is 30%, you will pay 30% of the cost of a covered service, and your insurance company will pay the remaining 70%.

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• Copay: A fixed amount that you pay for a covered healthcare service, regardless of the cost of the service. For example, you might have a $20 copay for each doctor visit. The cost of the copay may be more because we are a specialist and if we are out-of-network 

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• Deductible: The amount of money you must pay out of pocket for covered healthcare services before your insurance company starts to pay. For example, if you have a $1,000 deductible, you will pay the first $1,000 of covered services yourself before your insurance company starts paying.

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• Out-of-Pocket Maximum: The most amount of money you will have to pay for covered healthcare services in a single year. Once you have reached your out-of-pocket maximum, your insurance company will pay 100% of the cost of covered services for the rest of the year.

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• Allowed Amount: also known as the contracted amount, this is the amount a particular insurance company has agreed to pay for a covered service.  The insurance company then decides how much of the allowed amount they will pay, and how much the patient will need to pay. 

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• Claim: A request for payment that we (as the provider) submit to the insurance company after your visit.  It details the services we believe should be covered/payed.

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• Explanation of Benefits (EOB): An "explanation of benefits" (EOB) is a statement from a health insurance company that explains how they processed a claim. It explains the total cost of the services, how much your insurance company paid on your behalf, and how much they decide should be paid directly by the patient, if any.

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For a printable version of our Insurance Information form, click here.