Q?

What if my insurance covers my annual exam, but I have a problem I would like my doctor to treat at the same time?

A.

Because your health care is your doctor's primary concern, your doctor will be happy to address any additional concerns.

If the doctor needs to provide additional treatment or information about your additional concern, you may receive an additional charge. Here's why: Insurance carriers require accurate reporting from doctors when preventive care and additional problems are addressed during the same visit. So while you may be taking care of two health care concerns at one time, your insurer may see it as taking care of two office visits in one and assess your benefits accordingly.

Q?

What if during my wellness exam, my doctor recommends services not covered by my insurance?

A.

We are concerned that you receive the care you need, regardless of insurance coverage.

If your doctor orders tests or services that may not be covered, you may be asked to sign an advance beneficiary notice (ABN). By reading and signing this form, you agree to pay for the service if your insurance company denies coverage.

Q?

Are preventive services covered by health insurance?

A.

Coverage for preventive services varies among insurers. To determine your coverage, check your health insurance policy and contact your insurance company with any questions.

Medicare may pay for certain cancer screening tests, as well as diabetes monitoring and self-management. For more details, visit the preventive services section of Medicare's Web site.

Q?

What are preventive services?

A.

Preventive care is important to you and your doctor for your continued good health.

Preventive services or screenings may detect an undiagnosed disease, even if you do not have any signs or symptoms. Preventive services typically happen during an annual or wellness exam. They may include a complete physical exam, immunization advice, routine laboratory tests or X-rays, or guidance on diet, exercise, smoking cessation or other health issues.

Q?

May I request a change in the coding for a service I received?

A.

Federal law requires appropriate, accurate coding. Coding must reflect what happens during your medical visit and match what is recorded in your medical record.

When denied coverage, people sometimes are told that they would have been reimbursed for a specific procedure if another code had been used. But it's illegal to change codes just to obtain reimbursement. That's why it's important to understand your coverage so that you will not be surprised if a service is not covered.

Q?

How does my insurance company know what services I received?

A.

Each service a patient receives during an office visit has an American Medical Association code associated with it.

  • CPT (current procedural terminology) codes identify the services performed and the reason they were performed.
  •  ICD-9 (international classification of diseases) codes specify the diagnosis associated with your visit.
The billing statement for your visit includes these codes. They inform your insurer of the services provided and why they were provided.

Q?

What are my payment options?

A.

At the time of your visit, you can pay in full with cash, check, or by credit card (Visa, MasterCard, American Express or Discover).

Q?

When do I pay my co-pay?

A.

You should pay your co-pay or co-payment at the time of service. The amount is determined by your insurance plan.

Q?

How do I know if my insurance company will cover my visit or certain services?

A.

Coverage varies with each insurance company. So please refer to your insurance member handbook or call your insurance company with questions about what's covered.

Generally, clinic staff members do not know whether a service will be covered. Your insurance plan may not always cover medically necessary and appropriate services.

Q?

What ages does Cumming Family Medicine care for?

A.

All ages, from new born babies through senior citizens are welcomed at all Cumming Family Medicine locations.

Q?

Where can I find a Cumming Family Medicine Clinic?

A.

Cumming Family Medicine has four convenient locations:

Cumming Family Medicine - Main
765 Lanier 400 Parkway
Cumming, Georgia 30040
Phone: 770-205-1294
Fax: 770-887-4597

Dawson 400 Family Medicine
133 Prominence Court
Suite 230
Dawsonville, Georgia 30534
Phone: 770-205-1294
Fax: 770-887-4597

Foothills Medical Clinic
25 Foothills Parkway
Marble Hill, Georgia 30148
Phone: 770-894-4500
Fax: 770-894-4365

Cumming Family Medicine - Pirkle Ferry
303 Pirkle Ferry Road
Cumming, Georgia 30040
Phone: 770-887-5553
Fax: 770-781-2375