Craig A. Critchley, DO Richard E. Plumb, DO Christopher R. Cooley, PT Linda M. Davidson, RN, CNP Kendall J. Erdahl, MD Shruti S. Fernandes, MD James D. McNerney, DO James S. Burkhardt, DO Carla Christine Garber, RN, MSN, CNP, FNP-BC Click for map

Insurance

Upper Valley Family Care currently participates in the following insurance/managed care plans:

  • Aetna
  • Anthem
  • Direct Care America
  • Emerald Health
  • Great West
  • HealthSpan
  • Medical Mutual of Ohio
  • Medicare
  • Ohio Health Choice
  • Private Healthcare Systems
  • United Health Care

The specifics of insurance coverage varies by insurance carrier and by employer. The contract is between you and your carrier. We do not know the specific terms of your coverage. You should know how your coverage handles the following:

  • Copay

    A fixed amount you must pay on specific services. It is a requirement of your insurance carrier that you pay this at the time of service.

  • Deductible

    Amount you must personally pay before insurance will pay anything. This could be an annual total or an amount per episode of care in the case of hospitalization. You will receive a statement from us for anything applied to your deductible.

  • Co-insurance

    Percentage of the charge that you are responsible for. In some cases, this can be determined at the time of service. In most cases it is determined by filing an insurance claim. You will receive a statement from us for this amount.

  • Pre Certification or Prior Authorization

    Requirement that certain services be approved by the insurance carrier prior to having the service done. This could include imaging services such as CT scans and MRI, physical/occupational/speech therapy, hospitalization. If you have prescription coverage, many medications also require prior authorization.

  • Contracted Lab

    A few plans require lab testing to be performed by specific labs requiring special handling. If your plan requires lab to be done by Lab Corp, we cannot draw your lab in-house. You will need to go to either Compunet or the hospital for your lab draw.

  • Healthcare Savings Account or Reimbursement Account (HSA/HRA)

    Many of the above provisions still apply.