Understanding that we accept the insurances below BUT each plan is unique and there are no guarantees services will be covered. We will do our best to help you verify coverage before your first appointment.
We do not work with
Medicare
MaineCare
Humana
Wellcare
Naturopathic Care
No insurance accepted (as of 2024)
Massage Therapy
VA Community Care
Acupuncture
Anthem Blue Cross Blue Shield
Aetna
Cigna
United Healthcare
VA Community Care
MaineGeneral Horizon Program
Chiropractic
Anthem Blue Cross Blue Shield
Aetna
Cigna
United Healthcare
VA Community Care
Common Insurance Questions
It is important that you become familiar with your benefits as they are determined by your insurance company. MaineCHI accepts certain insurance as a courtesy to our patients. We do not determine your co-pay, out-of-pocket expenses or visit limits so it is important for you to review those benefits. Our office team will be happy to provide you with a copy of your benefits but also encourage you to review your plan.
What is a deductible?
The amount you pay for covered health care services before your insurance plan starts to
pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services
yourself. After you pay your deductible, you usually pay only a copayment or coinsurance for
covered services.
What is Co-Insurance?
The percentage of costs of a covered health care service you pay (20%, for example) after you have paid your deductible. Let us say your health insurance plan’s allowed amount for an office visit is $100 and your coinsurance is 20%. If you have paid your deductible: You pay 20% of $100, or $20
What is a Co-Pay?
A copay is a fixed amount that a patient must pay for a covered service—as determined by his or her health plan. Patients must pay their copays at the time of service
What are "in-network" or "out of network" benefits?
Out of network simply means that the doctor providing your care does not have a contract with your health insurance company. Conversely, in-network means that your provider has negotiated a contracted rate with your health insurance company, and this generally means less out of pocket expenses for you. Not all plans allow for out of network care so be sure to know if you have out of network expenses.
What is a "Visit Limit"?
Annual limits may be placed on the number of visits that will be covered for a particular service. After an annual limit is reached, you must pay all associated health care costs for the rest of the year.
What is an Out-of-Pocket Maximum?
The most you must pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits. This means sometimes can also include copays, but some plans have an exclusion.
Why does my insurance require a referral?
Your doctor keeps track of all your medical records and provides routine care. To see a specialist, you will need a referral from your primary care physician, except in an emergency. Without a referral, your insurance may not cover the cost of your care. Our office does not require a referral to be seen, however your insurance might.
Can a choose not to use my benefits and pay out of pocket?
Yes, you will just need to sign a form (only if we are in network with the insurance). This is sometimes more beneficial for those who have a high deductible.
What is the difference with insurance vs self-pay?
The insurance company determines the length and type of treatment.
Most insurance companies limit the choice of providers to in-network. This allows for them to determine what the reimbursement will be along with what your out of pocket will be.
Insurance companies can require authorizations and or referrals from your PCP or the Insurance company itself.
The insurance company requires medical information to authorize treatment. The provider may be required to provide not only a diagnosis, but also a treatment plan and progress notes. They can determine, even if you have coverage that the services are not medical necessary. This is why proper coding is essential to diagnose.
Insurance determine what services can be provided within each visit and may not cover combined services.
If you choose to be self-pay then you can choose what services you want, when and use our fee schedule.