Jeffrey Wade
Presbyterian Medical Group offers a range of insurance options for its patients. The group's hospitals and clinics accept cash, checks, debit, and credit cards for payment. They also offer a 25% discount on all services for uninsured patients and provide financial assistance and counselors to help patients who are uninsured or underinsured. Presbyterian Medical Group accepts most major insurance providers, including Medicare, Medicaid, and the Presbyterian Health Plan. The latter offers a choice of enrollment in a High Option, Standard Option, or Wellness Option.
| Characteristics | Values |
|---|---|
| Insurance accepted | Medicare, Medicaid, and Presbyterian Health Plan |
| Other payment methods | Cash, checks, debit and credit cards |
| Payment plans | Yes |
| Financial assistance | Yes |
| Prescription drug coverage | Yes |
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What You'll Learn
Presbyterian Health Plan
The health plan offers members a choice of enrollment in a High Option, a Standard Option, or a Wellness Option. The High Option and Standard Option emphasize preventive care such as routine office visits, physical exams, well-baby care, and immunizations, in addition to treatment for illness and injury. The Wellness Option focuses on social and wellness offerings, such as exercise classes, financial planning seminars, and support groups.
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Medicare
Presbyterian hospitals and clinics, including Presbyterian Medical Group, accept Medicare insurance. Presbyterian Healthcare Services is committed to improving access to healthcare and health insurance coverage for all.
Presbyterian Health Plan prescription drug coverage is expected to pay out as much as standard Medicare prescription drug coverage. This means that you do not need to enroll in Medicare Part D for extra coverage. However, if you do choose to enroll in Medicare Part D, you can keep your FEHB coverage, and your benefits will be coordinated with Medicare.
Presbyterian Health Plan works with individual providers, medical groups, and hospitals to provide benefits. These providers accept a negotiated payment, and patients are only responsible for their cost-sharing, including copays, coinsurance, deductibles, and non-covered services and supplies. The Federal Centers for Medicare and Medicaid Services have adopted the RBRVS method for Medicare reimbursement. RBRVS pays higher for evaluation and management services and lower for procedures. All providers are reimbursed for both evaluation and management services and procedures.
Presbyterian hospitals will provide necessary medical treatment in the event of an emergency, regardless of one's ability to pay. However, if your insurance is not in the Presbyterian Healthcare Services network, you must obtain prior authorization for all services.
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Medicaid
Presbyterian Hospital accepts most major insurance providers, including Medicaid. Medicaid is a government-funded program that provides critical assistance to individuals and families who may otherwise struggle to afford essential medical care. Medicaid has become a lifeline for millions of Americans, allowing them to receive the care they need without the heavy financial burden.
Through Medicaid, eligible participants gain access to a wide range of healthcare services, including help with paying for doctor visits, prescriptions, hospital stays, and more. This broad coverage allows access to a full spectrum of healthcare options, promoting both short- and long-term health. Presbyterian Healthcare Services is committed to improving access to healthcare, and so uninsured patients are offered a 25% discount on all services and are provided with an estimate of the cost. This allows patients to make an informed decision about whether to proceed with the requested services.
Financial assistance and counselors are available to patients who are uninsured or underinsured and are having difficulty paying for their care. Payment options, including payment plans, are offered to those who qualify, and charity assistance is also provided. In the event of an emergency, Presbyterian will provide the necessary medical treatment regardless of one's ability to pay.
Presbyterian Health Plan, which is part of Presbyterian Health Services, holds accreditations from NCQA and/or local plans and vendors. This plan requires members to see specific providers, hospitals, and other healthcare professionals that contract with them. These providers coordinate the healthcare services of those enrolled in the plan. Members are given a choice of enrollment in a High Option, a Standard Option, or a Wellness Option. HMOs under this plan emphasize preventive care, such as routine office visits, physical exams, well-baby care, and immunizations, in addition to treatment for illness and injury.
The Office of Personnel Management (OPM) has determined that the prescription drug coverage of the Presbyterian Health Plan is expected to pay out as much as standard Medicare prescription drug coverage. This means that enrollees do not need to enroll in Medicare Part D and pay extra for prescription drug coverage.
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Financial assistance for uninsured patients
Presbyterian Healthcare Services offers financial assistance and counselors to patients who are uninsured or underinsured and have difficulty paying for care. This includes non-emergency services provided at Presbyterian-owned facilities for those who qualify. Presbyterian hospitals and clinics, including the Presbyterian Medical Group, accept cash, checks, debit, and credit card payments.
Presbyterian offers payment options and payment plans for those who qualify, as well as charity assistance. Providers in certain rural clinics may offer a sliding scale discount for eligible uninsured or underinsured patients. This discount is based on family income and the number of family dependents. Services that may be included in the sliding scale discount are family medicine, internal medicine, pediatrics, behavioral health, and obstetrics/gynecology.
To apply for financial assistance, patients can complete an online application, fill out a printable application, or visit the nearest Presbyterian facility and ask to speak with a Patient Service Representative.
In the case of a medical emergency, Presbyterian will provide the necessary medical treatment regardless of one's ability to pay. However, if a patient's insurance is not in the Presbyterian Healthcare Services network, prior authorization for all services is required. It is important to note that prior authorization does not guarantee payment or in-network benefits.
Presbyterian Health Plan is also an option for patients. This plan holds accreditations from NCQA, and patients can choose from a High Option, Standard Option, or Wellness Option. The plan emphasizes preventive care and covers routine office visits, physical exams, well-baby care, and immunizations, in addition to treatment for illness and injury.
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Payment methods
Presbyterian Hospital accepts most major insurance providers, including Medicare, Medicaid, and Presbyterian Health Plan. Presbyterian Health Plan is offered to groups and employers, and patients have a choice of enrollment in a High Option, a Standard Option, or a Wellness Option. The plan holds NCQA accreditation.
Presbyterian Health Plan requires patients to see specific providers, hospitals, and other medical groups that contract with them. These providers coordinate healthcare services and are selected by Presbyterian Health Plan.
For insured patients, Presbyterian Hospital accepts payment in the form of copayment, deductible, and/or coinsurance. For uninsured patients, payment in full is required, although Presbyterian offers a 25% discount on all services. Presbyterian also offers uninsured patients financial assistance and payment options, including payment plans and charity assistance. Presbyterian hospitals and clinics accept cash, checks, debit, and credit cards for payment.
Presbyterian Medical Services also partners with counties, organizations, school districts, government agencies, hospitals, and providers to provide needed programs to underserved communities and patients. They offer a sliding-fee schedule for patients who have no insurance.
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Frequently asked questions
Presbyterian Hospital accepts most major insurance, including Medicare, Medicaid, and Presbyterian Health Plan.
Yes, Presbyterian offers financial assistance and counselors for patients who are uninsured or underinsured and have difficulty paying for care. They also offer payment options, including payment plans and charity assistance.
Yes, the Office of Personnel Management (OPM) has determined that Presbyterian Health Plan prescription drug coverage is considered Creditable Coverage. This means you do not need to enroll in Medicare Part D and pay extra for prescription drug coverage.
