Insurance & Billing
Commercial Insurance
Peachtree Women's Clinic accepts a wide variety of commercial insurance plans. Please contact your insurance company to see if we are on your plan or call our office to ask. It is the patient's responsibility to ensure that Peachtree Women's Clinic is on your plan.
With traditional insurance, all our providers accept the same insurance plans. Therefore, if your provider no longer accepts your insurance, none of our providers will accept your insurance.
Medicaid Plans
Peachtree Women's Clinic accepts a variety of Medicaid plans. Please contact our office for specific questions about Medicaid plans.
Medicare Plans
Some of our providers accept traditional Medicare as well as many Medicare Advantage Plans. If your provider is not a Medicare provider, you have the option to continue to see your provider and be billed the self-pay rate or switch your care to a Medicare Participating Provider.
What Does My Insurance Cover?
Private/Commercial Insurance
Most private insurance companies pay for a yearly well woman visit. Many will require a full 365 days between well woman exams, some will allow one well woman visit per calendar year. It is the patient's responsibility to know how your insurance works. We do not call your insurance to verify if it is time for your well woman visit.
Medicare
Medicare, with or without a supplement, will pay for a collection of a pap smear (Q0091) and performance of breast/ pelvic exam (G0101) every 24 months. For certain high-risk conditions, these services can be performed every 12 months. Most all patients are low risk.
- They do not pay for a well woman visit.
- They do not pay for HPV testing.
- They do pay for problem visits which can be more comprehensive and include many of the same components of the well woman visit. During a problem visit, the pap smear (Q0091) and breast/pelvic exam (G0101) can be performed also. Problem examples are questions about cancer, questions about female anatomy or disease, painful urination, frequent urination, any urinary complaints, vaginal bleeding, painful intercourse, vaginal discharge, pelvic pain, menopause questions, review of ultrasound and CT scans for female anatomy and many more. There is no limit to the number of problem visits to a gynecologist. A "problem" visit can just be a discussion of your concerns.
Medicare Advantage Plans (plans that include your Medicare and supplement into one)
Each plan is different, and some may include a well woman visit. Some plans cover only what Medicare covers (collection of pap smear and breast/pelvic exam). We do not know the specifics of each plan and we will not get this information before your visit.
Office Billing Practices
Private/Commercial Insurance
Traditional insurance covers a well woman visit; therefore, we will bill your insurance and not ask for you to pay anything at the time of your visit.
Medicare and Medicare Advantage
Medicare and Medicare Advantage plans will not cover a well woman visit. We will have you sign an advanced beneficiary notice (ABN) stating that you are aware that Medicare does not cover the well woman visit. We will bill the insurance, and you will receive a bill for what Medicare does not cover. Sometimes a well woman visit is scheduled but it can be billed as a problem with the Medicare pap (Q0091), breast/pelvic exam (G0101) being added to the problem. Our office will bill Medicare directly for any problem visit, ultrasound, biopsy and mammogram. Medicare pays for most problems and procedures.
