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Insurance and Self-Pay

Healthcare is complicated and we are here to help you navigate the system.

Bill Pay Insurance Self-Pay Options Patient FAQs

Insurance and Billing

Pay Your Bill Online

We offer convenient online billing through our secure portal. If you have any questions, please review our billing FAQ for answers to common billing questions.
If you wish to speak to someone in the billing department, please call 919.237.1337

Insurance Accepted at Avance Care

Avance Care participates with most major insurance carriers. If you have questions regarding coverage, and what (if any) co-payments, co-insurances, or deductibles will be your responsibility, please contact your employer or your insurance company. Note: Patients with high deductible plans, who have not met their deductible, will be charged $150 at the time of service.

This list covers insurance plans accepted by Avance Care. It is not all-inclusive, is updated periodically, and may be subject to change.

Accepted Insurance Plans

Avance Care is currently in-network with the following insurances:

Aetna (except for Duke Basic/Select)
BlueCross BlueShield
Cigna (except for Cigna Sure Fit)
Great West Healthcare
Humana
MedCost
Medicare
UnitedHealthcare (excluding Avance Psychiatry)

View a full list of in-network insurance plans.

Medicare Advantage Plans

We accept most Medicare Advantage plans.

Medicare Advantage PPO plans

You can see Avance Care anytime without any prior authorizations.

Medicare Advantage HMO plans:

If your health insurer has assigned your Avance Care doctor as your primary care physician, you can see Avance Care anytime without any prior authorizations.
If your health insurer has assigned a non-Avance Care doctor as your primary care physician, please have your assigned PCP obtain a prior authorization before seeing Avance Care.

Medicaid

The following locations are accepting new patients with Medicaid

In the Triangle (Raleigh-Durham-Chapel Hill):

Avance Care Broad Street – 2400 Broad Street, Suite 1, Durham, NC
Avance Care Pediatrics – 300 Market Street, Suite 112, Chapel Hill, NC
Avance Care Fuquay Varina – 400 Attain Street, Suite 202, Fuquay Varina, NC

In Charlotte:

Avance Care Matthews – 855 Sam Newell Road, Suite 205, Matthews, NC

View a full list of in-network insurance plans.

If you have any questions about your coverage, please contact your insurance company.

Self-Pay Options

Insurance is not required to be seen in our office. Avance Care provides a prompt-pay discount to self-pay patients if you do not have health insurance or we are out-of-network.

We understand the need for cost-effective medical care with cost transparency. View our fee schedule so you can make an informed decision.

Self-pay fee schedule

To learn more, visit our Frequently Asked Questions.

Getting to Know Your Insurance Benefits

Knowing and understanding your insurance benefits takes much of the financial surprise out of healthcare.

Some insurance policies require that a deductible be met before coverage begins. For example, if you have a $1,500 deductible, you must pay that amount before expenses are covered by the insurance company. Your insurance company can tell you how much of your deductible has been met to date.
Other insurance plans have a coinsurance requirement, which means the patient and the insurance company each pay a specific percentage of the day’s visit. Your insurance company can provide information about the allowable amounts.
Some plans require that the patient pay a set amount for each visit. This may or may not include any tests or procedures associated with the visit.
Some plans require a co-pay for the office visit, and then have a deductible for labs and/or procedures.
Some insurance policies may also have a combination of deductibles, coinsurance, and co-pays. For example, a policy may require a subscriber to meet a $1,500 deductible, after which the subscriber is required to pay 10% coinsurance.
In almost all cases, payment is required at the time of visit, whether it is a deductible, a co-pay, or payment for any non-covered services.
We are required by our insurance contracts to collect all co-pays and other patient responsible amounts, at the time of service.
If you have not met your deductible – we will estimate the expected insurance payment for your visit and request that amount at check-out. This is an estimate only – you may receive a statement with additional balances after your visit. Charges are finalized after the medical claim has been processed by your insurance company.
You will be expected to pay in full if:
- You do not have insurance
- We do not participate with your health plan
- You have an HMO Plan where we are not listed as your Primary Care Provider (PCP)
- You are unable to present a valid member identification card from your insurance carrier at your visit
- We are unable to verify your insurance coverage at the time of service
For additional details please refer to our Patient Financial Policy, available at Front Desk.
School, Sports, Camp, Work, Scout, and College Physical Exams are not normally covered by insurance plans.
Insurance plans typically cover one regular physical exam per year. Some plans waive patient responsibility for annual physical exam, while others expect member to pay applicable deductible, co-pay, or coinsurance for the visit.
Services that are not normally covered by insurance plans during a physical exams:
- Evaluation and Management of specific acute problems or illness. Example would be discussion of a recent cough and sore throat, pain or injury.
- Procedures other than a pap smear. Example would be mole removal, joint injection, and skin biopsies.
For additional details please refer to our Insurance Coverage of Physical Exams Notice, available at Front Desk.
It is very important to understand your insurance coverage so you will not be surprised if a specific type of service is not covered by your policy. Billing must reflect what happened during your medical visit and match what is recorded in your medical record. Appropriate billing is a federal legal requirement, it is considered fraudulent to change billing information solely to obtain reimbursement.
In order to help compensate for our higher operating costs during evenings (starting 6 PM) and weekends, Avance Care uses Extended Hours Service specialty code while submitting insurance claim on your behalf for non-preventive care visits. The fee for this service code is up to $50. This fee is added to the baseline charges for your visit. Most insurance companies recognize this billable charge and will provide full or partial reimbursement. You may be responsible for only the allowable portion of this charge in the event that your insurance company assigns it to your deductible or coinsurance.
Yes. Most major insurance plans are accepted. We will also file your claim for you; however, any co-pays, deductibles, or non-covered services must be paid at time of services rendered. We also accept Cash, Discover, Visa, and MasterCard.
Yes. In almost all cases, some payment is required at the visit, whether it is a deductible, a co-pay, or payment for any non-covered services.
Avance Care has an in-office clinical laboratory that provides testing for some lab tests your physician will order. However, we are not able to provide many other tests. For these tests, we send the specimen to LabCorp and LabCorp will file your insurance. If your insurance does not pay the balance in full then LabCorp will bill you for the balance due.

Billing or Insurance Questions?

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