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Financial Policy

Preventive services and Office visits at the same appointment

Preventive visits include age-appropriate screening for disease prevention and immunization counseling. A preventive care visit is different from an office visit:

The purpose of a preventive visit is to review your overall health, identify risks and find out how to stay healthy. Your plan should cover 100% of a preventive visit when you see a doctor in your plan network. For example, a visit for screening for chronic diseases such as hyperlipidemia, diabetes, colon cancer, breast cancer or cervical cancer would be a preventive visit.

The purpose of an office visit is to evaluate and treat a specific health condition. For example, at your preventive care visit you ask your doctor about a specific health concern or condition that requires further evaluation or a new treatment such as joint pain, elevated blood pressure readings, a changing skin lesion, or changes in your mood. These problems would be addressed as an evaluation and management or office visit.

You may have to pay for the visit as part of your deductible, copay and/or coinsurance

Referrals
Some medical issues require testing or specialty appointments. We can refer you to providers at UVM or outside the UVM network if that is in the best interest of your health, or if that is your preference. If you have not been seen for a problem within 3 months and you are seeking a specialist referral, please make an appointment. Specialists generally require a visit with your PCP within 3 months of the referral. Our staff will work with you to get specialist referrals scheduled at a practice that works well for you.
Insurance coverage

Payment for services that have been submitted to your insurance company and determined to be your responsibility is due upon notification by statement.

Please note, you are responsible for knowing the extent of your insurance coverage prior to your visit. To confirm your plan is in-network, please contact your insurance carrier and reference the following NPI numbers:

  • Dr. Sam Russo: 1891828398
  • Katlin Mostue-Nesbit, APRN: 1427665017

Currently, we are in-network with the following insurance plans:

  • Blue Cross to include BCBS of Vermont, Federal BCBS, CBA Blue, and Vermont Blue Advantage (UVM Retirees only)
  • Cigna
  • MVP
  • Vermont Medicaid
  • Aetna: We are in-network for some plans. Check with your plan.

Payment for all other services, including out-of-network services, co-pays, and non-billable laboratory tests, is due at the time of service by cash, check, or credit card (Visa, MC, Amex).

Missed Appointments

You will be billed for missed appointments without 24-hour notice.

Prior Authorization
Some testing and specialist referrals require prior authorization from your health insurance. Our staff will work with your insurance company to obtain the authorization. This process can take multiple days to complete. If your insurance denies an authorization, you and your provider may opt to go with a different plan of care.
Services outside of an office visit

These will be billed to your insurance carrier, and patients will be responsible for any copayment, deductible, or non-covered services. These services include:

  • Initiation of services that require evaluation and management through the patient portal or by telephone
  • Refill requests when an office visit is due
  • Resubmitting orders for laboratory testing or diagnostic imaging due to expiration (orders are good for 3 months)
  • Completing specialist referrals requested outside of an office visit
  • Completion of letters and forms outside of an office visit

The CPT codes for these services will be used to submit a claim to your insurance company (if applicable): 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98012, 98013, 98014, 98015, 98016.

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321 Main St.
Suite B
Winooski, Vermont, 05404

P: 802.636.4133
F: 833.464.3117

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