Overview

Vanguard Medical Group participates with most major insurance plans.

We will submit charges to any insurance plan with which we participate. Insurance co-payments are due at the time of your visit. For individuals not covered under such an insurance plan, we request payment for office services be made at the time of your visit.

Managed Care plans may require you to select a doctor as your Primary Care Physician (PCP). This should be done prior to visiting our office.

If you do not have insurance or have a high deductible plan that we do not participate with, you may want to consider our Direct Pay Primary Care Plan. This plan gives your access for all your primary care needs for a low monthly payment. Click here to see if the Direct Pay Primary Care Plan is available at your Vanguard office location.

Health Insurance and Your Health

With the Affordable Care Act in place, the insurance industry, employers and individuals are examining their healthcare benefits and in some cases making changes. It is all in an effort to mitigate the high costs of healthcare, especially when more of the cost may be shifted to the consumer. Whether you ‘shop’ for insurance or maintain your employer’s policy, we understand the burden that higher out-of-pocket medical costs can bring to our patients. We’re working with you to help you manage those costs and understand your insurance benefits.

Our Role: Reducing Out-of-Pocket Costs

At Vanguard Medical Group, we work to help reduce the direct costs to you. Here are just some of the ways.

  • For any procedure we recommend, we consider both medical necessity and cost effectiveness. For example, we advise when testing might be unnecessary or when it can wait.
  • We consider the cost every time we write a prescription–and provide generics when possible.
  • We also check to make sure your care is within your health plan’s network.
  • When you need a specialist, we collaborate, when possible, with those who are high quality and cost-effective. We will coordinate your care by sharing with you and the specialist any relevant prior testing to avoid unnecessary duplication.
  • If you are a Medicare enrollee, click here to learn more about Medicare Annual Wellness Visits.

Your Role: Healthy Lifestyle

Did you know that smoking, drinking, obesity and lack of exercise lead to health problems that account for more than 30 percent of healthcare costs?  The lifestyle choices that you make can go a long way toward keeping you healthy. We can help guide you in lowering your healthcare costs by encouraging you to incorporate healthy choices and changes in your lifestyle.

  • Eat a healthy balanced diet
  • Maintain a healthy weight
  • Exercise regularly
  • Reduce stress
  • Avoid cigarettes and alcohol
  • Schedule annual physicals
  • Get immunizations and screenings when recommended

Ask us. We’ll help you develop a personalized healthy lifestyle program.

 For More Information

There’s still a lot of confusion about insurance. Here are links to sites that can help explain the current insurance market.

Questions & Answers

Q. What is an insurance copayment?

A. A copayment, copay or encounter fee is the amount of money your insurance plan requires you to pay at the time of your visit.

Q. Am I required to pay a copayment every time I visit the office?

A. Generally, our staff will collect a copayment every time you see the doctor for an office visit. Insurance company rules regarding copayment collection for lab work, immunizations, office surgeries, etc. vary depending upon the type of insurance involved.

Q. My insurance plan has a deductible and co-insurance. How will I know what I am required to pay?

A. Any insurance plan deductible and co-insurance is the patient’s responsibility. You will receive a bill from us after we have received your insurance company’s payment. You should also receive an Explanation of Benefit from your insurance company, which will indicate the patient’s financial responsibility.

Q. Why did I receive a bill when I paid my copayment at the time of my visit?

A. There are a number of different reasons you could receive a bill from us in addition to your copayment:

  • Some insurance plans require a deductible for laboratory services, immunizations, minor surgical procedures or hospital visits, etc. In that case, you would be responsible for any charges put toward your deductible.
  • Some insurance plans require you to select a primary care physician. If you have not done this, your insurance company will consider your visit to be “out-of-network” even though we participate with your plan.
  • Your insurance plan may not cover visits for obesity, pre-employment exams, school or sports physicals, cosmetic removal of moles and lesions, or any other diagnosis they deem not medically necessary.

Q. How do I contact Vanguard Billing?

A. Phone: 973-559-3700 / Fax: 973-559-8650 / e-mail: billing@vanguardmedgroup.com

Q. Both my spouse and I work and have dual coverage through our employers. Why can’t I choose which plan I want to use?

A. The insurance industry developed an industry-wide agreement, which determines which plan pays first. Generally, the plan covering the patient as the employee pays before the plan covering the patient as the dependent spouse. Therefore, your employer’s insurance plan would be primary on you and the coverage through your spouse’s employer would be considered secondary.

Q. Which plan would be primary for our children?

A. The order of benefit determination depends upon the birth date (month and day) of the parents. The plan covering the parent whose birthday occurs earlier in the calendar year is considered primary. For example, if the child’s mother was born on March 27th and the father was born on August 7th, the mother’s insurance plan would be primary.