When your foot is in pain and you need help, you don’t want to think about how to pay for the treatment you receive. As long as our current health insurance system is in place, however, it is something you need to pay attention to or you may have to cover the expense completely on your own. We want to share how our office works with insurance companies for your services to be covered.
Insurance We Accept
Health insurance is complicated and it seems every plan and every medical provider has differences in what is covered and for how much. The Yuko Miyazaki, DPM practice in Berkeley is contracted with most major Preferred Provider Organizations (PPOs) in our area, so if your coverage is that type, you are free to choose us for your care—usually at less cost than you normally would pay for those services on your own. We also accept Medicare patients.
There are a couple of insurance arrangements our office does not participate in:
- We are not a Health Maintenance Organization (HMO) contractor. We would not be your primary care physician who coordinates all your care and refers you to specialists. However, we can treat you if your HMO physician refers you to our care.
- We are not a Workers Compensation practice. We do not treat work-related injuries that are covered under Workers Compensation insurance. Your employer may be able to help you find a provider that does.
What Does Insurance Cover?
Insurance helps pay for approved medical expenses, but even full-coverage plans will often require you to pay at least something for your care:
- Your Deductible is a set amount that you have to pay for your medical care in a given year before your insurance starts paying. That can range anywhere from a few hundred to several thousand dollars depending on your plan. After you have met this deductible, your insurance plan helps cover your costs.
- Your Copay is a set fee that you pay at the time of your visit, such as $25 for a regular office visit, $50 for specialist consultation, $15 to get a prescription filled—whatever amounts your plan has set for these basic services.
- Your co-insurance amount is your portion of further costs for your care. You may have an 80/20 plan, where you pay your deductible amount, copay, and 20% of the remaining charges, while the insurance company pays the remaining 80% of approved charges (or a 90/10 or 70/30 plan).
- If you have any questions about what your plan covers and what you need to do beforehand to make sure it is (pre-approvals for tests, referrals from your primary care physician, etc.), please call the number on your insurance card and ask them to clarify the situation for you.
Other Payment Options
If you do not have insurance coverage, you can self-pay for your care at the following rates (subject to change without notice):
- Initial office visit $150
- Follow-up visit $70
- Toenail Avulsion $200 Each
- Orthotics (biomechanics evaluation, casting, dispense, and 2 follow-up visits) $400
- X-ray $50
- Ingrown Toenail $200 for the first one; $150 for more
We hope this has helped you understand health insurance a bit better. If we can answer any questions for you, please call Yuko Miyazaki, DPM in Berkeley, CA at (510) 647-3744 and speak with the office manager. You can also ask us general questions using our online contact page. We look forward to helping you solve your foot issues—from heel pain to skin and nail problems!