Insurance Approvals: Eligibility and Prior Authorizations

 Related information

  • Private insurance plans
  • Out-of-Pocket Pricing Options – Out-of-pocket pricing options may vary according to a patient’s needs. Please contact the clinic to get an accurate information before scheduling an appointment

Alpha Men’s Primary Care doctor will decide which procedures, tests and other consultations you may need. However, many health plans require eligibility and sometimes predetermination of medical necessity prior to care being rendered. In addition, some services may not be a covered benefit for some plans. Investigating coverage requirements and limits can take up to six weeks, and some services require eligibility staff to supply photos and medical necessity information to your insurance company.

For example, services that may require eligibility include inpatient hospital services, observation services, invasive procedures, CT, MRI and PET scans.

Patients are responsible for knowing the eligibility requirements of their health plans. Alpha Men’s Primary Care highly recommends that you contact your insurance company to determine benefits and coverage for the Alpha Men’s Primary Care location at which you plan to be seen.

  • Managed care plans such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) may deny or reduce benefits if care is obtained outside of the established network or authorization of the plan.
  • Patients’ plans that require prior authorization or eligibility may provide only a reduced insurance payment if not previously authorized. In such cases, the patient will be financially responsible for more — possibly all — of the provided services.
  • A pre-service deposit may be required for non-authorized visits.
  • To avoid paying a pre-service deposit or experiencing either denial of payment or a reduction of benefits, Alpha Men’s Primary Care highly recommends you contact your insurance carrier prior to services to determine plan requirements or limitations to receiving care at the Alpha Men’s Primary Care site at which you will receive services.

 Before scheduling a second-opinion consultation at Alpha Men’s Primary Care

Address any second-opinion requirements with your insurance company. The insurance company can tell you whether it covers second opinions and whether any eligibility requirements apply.

Please contact us to verify that Alpha Men’s Primary Care has received your authorization:

 Options:       

In the event your insurance provider will not cover the said procedures not to worry. We offer various options for our patients to still get procedures, tests and other consultations you may need. We offer: Membership Plans, Care Credit, in house payment options. Please speak to a Treatment Counselor for more information or to BOOK APPOINTMENT

Alpha Men’s Primary Care

  1. 956-441-2188 Office
  2. 956-350-8371 Fax
  3. 8 a.m. to 6 p.m. Central time, Tuesday through Friday

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