Insurance and Government Programs
Insurance companies with which we participate:
- Interplan Health Group*
- Community Based Health Plans - CBHP-RPS*
- Corvell Corporation *
- Employee Benefit Services (EBS)*
- River Valley, Inc
- Keokuk Organized Delivery System (ODS) *
- Wellmark Blue Cross/Blue Shield (Wellmark HMO plans not included)
- Multiplan (Does not include Unitedhealth Care)
- Riverquest (Quincy Health Plan)
- Mutual Medical
- Coventry
*These companies have contracted through the Mississippi Valley Independent Practice Association (MVIPA). If your company is not listed and would like to look into contracting through the MVIPA, please contact them in writing at MVIPA, P.O. Box 852, Burlington, IA 52601.
Government Plans with which we participate:
- Consultec - Title XIX Iowa
- Consultec - Title XIX Medipass (Referral required from Primary Care Physician)
- Triwest - Champus Standard, not the HMO
- WPS - Medicare Standard
- United Health Care - Medicare Railroad Only
Please bring your insurance card with you to your appointment and inform the front desk of any changes.
Any co-payments required by your plan are due at the time of your visit.
Please know what items your policy will cover, as most insurance companies will pay for office visits and procedures, but may not cover for yearly exams. If expensive test or procedures are anticipated or planned, we try and discuss this with you beforehand.
Medicare
Pap Smears and Pelvic Exams
Medicare pays for routine screen pap smears and pelvic exams (including a clinical breast exam) every two years. If the patient is at high risk for cervical cancer, Medicare covers an annual pap smear and pelvic exam. Medicare pays for diagnostic pap smears whenever they are ordered by a physician.
A screening pap smear and pelvic exam is done when the patient has no symptoms or signs that there is anything wrong. It is usually ordered as part of a routine physical exam, and often includes a clinical breast exam.
If the patients doctor recommends that the patient have a pap smear more often than every two years because the patient is at high risk of cervical or vaginal cancer, based on the patients medical history or other findings, Medicare pays for an annual screening pap smear and pelvic exam. If the patient is a Medicare patient of childbearing age, Medicare pays for an annual screening pap smear if the patient has had a pap smear during the preceeding three years indicating the presence of cervical cancer.
When the patient has a screening pap smear the deductable is waived, but the patient must still pay the 20 percent coinsurance. Medicare will pay the doctor directly. Other than coinsurance the patient will not have to pay any additional money to the doctor for a covered pap smear.
A diagnostic pap smear is done when the patient has a previous diagnosis of cervical cancer or significant signs or symptoms that make the doctor suspect cancer is present. Medicare pays for a diagnostic pap smear whenever one is ordered.
Breast Cancer Screening
Medicare pays for routine screening mammograms annually for women over 40. Medicare pays for a diagnostic mammogram whenever it is ordered by a physician.
A routine screening mammogram is done when the patient has no symptoms or signs that there is anything wrong. It is usually ordered as part of a routine physical exam. Medicare B helps pay for routine screening mammograms for the detection of breast cancer if the service is provided by a Medicare-approved supplier. If the patient age 40 or older, Medicare will pay for a screening mammogram every 12 months. The Medicare deductable will not be applied to this service, but the patient will have to pay the 20 percent coinsurance amount.
A diagnostic mammogram is done when the patient has signs or symptoms that make the doctor think that a closer look is needed in order to make a diagnosis. Medicare Part B helps pay for diagnostic mammograms for symptoms which include breast discharge; a mass, knot, or lump that the doctor can feel; or pain in the breast area. If you have a personal history of breast cancer, Medicare will also pay for a diagnostic mammogram. You will have to pay the deductible and 20 percent coinsurance for this service.
A diagnostic mammogram is normally used if the doctor has scheduled a follow-up visit after something was detected on a screening mammogram, or as a result of a biopsy.
If you any any questions regarding what Medicare covers, call 1-800-532-1285.