Understanding Your Medical Bills and Insurance

Omic Wellness is an independent, physician-owned private practice—a model of care that is becoming increasingly rare. Unlike large corporate healthcare systems that are often managed by private equity and staffed primarily by non-physicians such as PAs and NPs, we are fully dedicated to providing high-quality, personalized care directly from a physician. As a small, family-run business, we rely heavily on our patients’ commitment to paying their balances to sustain our practice and continue offering this level of care.

Many patients are surprised to receive a bill when they have insurance. However, in our experience, you should expect to receive a bill, as a fully covered visit is the exception rather than the rule. It is important to understand that federal agencies (not us) set reimbursement amounts and insurance companies use this to determine payment and typically cover only a portion of the total. Any balance you receive is the amount your insurance did not cover, such as co-pays & deductibles. Omic Wellness does not engage in “balance billing,” as we are considered in-network with most insurance companies.

We encourage all patients to familiarize themselves with their insurance coverage, as it is your responsibility to understand your plan. While we can provide general billing information, it is not feasible for us to contact your insurance company on your behalf to clarify coverage details.

Insurance coverage can vary significantly depending on your plan:

• HMO vs. PPO: HMOs require you to stay within a specific network and have a co-pay per visit, while PPOs offer more flexibility but have both co-pays and deductibles resulting often in a $0 reimbursement to the doctors office (thus the patient bill).
• Medicare Options: Traditional Medicare typically covers 80%, leaving the remaining 20% as patient responsibility unless you have supplemental coverage. Medicare Advantage plans function differently, often with network restrictions. Roughly 50% of our medicare patients receive a bill for one reason or another given the increased complexities of medicare today.