Appointments, Pricing & Membership

Flexible care options for patients in California and Alaska, including insurance, private-pay visits, and membership-based care.

Health Insurance & Coverage

Be Well Medical Group is in-network with select insurance plans. Coverage varies by state, service type, and whether you are a new or established patient.

Alaska

We continue to accept insurance for eligible Alaska patients, including Alaska Medicaid, Aetna, Curative, and Moda Health, including Moda Select, Connexus, Endeavor Select, Pioneer, and Tier 1 plans.

California

Be Well Medical Group is in-network with Optum and Aetna for behavioral health services, and with Curative for both medical and behavioral health services.

For patients with other medical insurance plans, we may be able to provide out-of-network care. Patients seeking ongoing primary care may also choose our Direct Primary Care membership for $150/month.

Our Direct Care Membership may also be used for eligible mental health and other ongoing medical services when appropriate.

New Patient Evaluations:

Extended Evaluations – 60 Minutes ($400)

Comprehensive initial evaluation for more complex concerns, including mental health, hormone care, multiple medical issues, or care that requires extra time and planning.

Standard Evaluations: 30-40 Minutes ($300)

Initial visit for focused concerns, general medical care, medication review, preventive care, or starting care when a full 60-minute visit is not needed. Available by telehealth or in person when appropriate

Ongoing Care: Choose from your options:

Services Not Included in Membership

Addiction Medicine

Addiction medicine services, including treatment for opioid use disorder and alcohol use disorder, are not included in the membership program and are billed separately on a fee-for-service basis.

Because these services often involve greater clinical complexity, more frequent monitoring, refill coordination, safety planning, documentation, and additional clinical oversight, they are provided through a separate care structure rather than through the monthly membership.

ADHD Evaluations

Initial ADHD evaluations are not included in membership because of the time and assessment required.

Initial ADHD Evaluation: $700

The initial evaluation includes an extended assessment. ADHD diagnosis may require more than one visit when clinically appropriate.

Ongoing ADHD follow-up may be available through private-pay or membership care depending on clinical needs, visit length, medication monitoring, and applicable regulations.

Affordable Labs & Diagnostic Imaging

We work with laboratory and diagnostic partners to help patients access competitive self-pay pricing when appropriate.

Direct Care members receive an additional $20 discount on the laboratory panels listed below.

Category	Tests Included	Total
General Labs	Complete Blood Count, Comprehensive Metabolic Panel, A1C (Diabetes), Cholesterol, Thyroid (TSH)	$95
Hormone Panel (Basic)	Complete Blood Count, Comprehensive Metabolic Panel, Total Testosterone	$75
Hormone Panel (Comprehensive)	Complete Blood Count, Comprehensive Metabolic Panel, Total Testosterone, Estradiol (Estrogen)	$105
Micronutrient Panel	Iron, Ferritin, Vitamin B12, Folate, Vitamin D	$100
X-Ray	Chest	~$40
Ultrasound	Pelvis	~$125-250
CT	Abdomen / Pelvis	~$250
MRI	Knee	~$300

Pricing is subject to change based on market conditions and partner/vendor rates. We’re happy to confirm current pricing before services are ordered.

KEY HEALTH INSURANCE TERMS

Deductible

A deductible is the amount you must pay for healthcare services before your health insurance begins to cover costs. For example, if your deductible is $1,000, you must pay $1,000 out-of-pocket for medical services before your insurance starts covering a portion of the costs.

• Example: If you visit the doctor and the cost is $200, and you haven’t met your deductible, you’ll pay the full $200. Once you reach your deductible, your insurance will begin sharing the cost of services with you.
• Some health insurance plans the deducitble does not apply to primary care services if the provider is in-network. Please check with your insurance prior.

Out-of-Pocket Maximum

The out-of-pocket maximum is the most you will pay in a policy period (usually a year) for covered healthcare services. Once you reach this limit, your insurance pays 100% of covered services for the rest of the policy period.

• Includes: Deductibles, copays, and coinsurance count towards your out-of-pocket maximum.
• Does Not Include: Premiums (the monthly fee you pay for insurance) do not count towards the out-of-pocket maximum.

In-Network Providers Copay

A copay is a fixed amount you pay for a specific healthcare service, such as a doctor’s visit or a prescription, with an in-network provider. Copays are usually due at the time of service.

• Example: Your health insurance might require a $20 copay for a primary care visit and a $50 copay for a specialist visit.

Co-Insurance

Coinsurance is your share of the costs of a healthcare service, calculated as a percentage of the total cost of the service, after you’ve met your deductible. Sometimes coinsurance varies between in-network and out-of-network providers.

• Example: If your coinsurance is 20% with an in-network provider and the total cost of a service is $100, you will pay $20, and your insurance will pay the remaining $80. If your coinsurance is 30% with an out-of-network provider, you will pay $30 and your insurance will pay $70. If seeing an out-of-network provider, typically you will pay for your healthcare services in total up-front, and then you will submit the Superbill to your insurance for reimbursement.

Important Notes

Deductibles Must Be Met: Before your insurance covers any portion, you must pay your annual deductible. Deductibles vary widely between plans, so check with your insurance for specifics.

Annual Exams: Some plans fully cover annual exams, even if the deductible hasn’t been met. Contact your insurance to confirm.

Coverage Varies: Final reimbursement depends on your insurance company’s contracted rates and your specific policy terms.

Why Choose Be Well Medical Group?

• Affordable Rates: We strive to keep our fees economical to ensure access to quality care.
• Transparency: We provide upfront pricing and can assist you in understanding your insurance coverage.
• Comprehensive Care: Our team focuses on patient-centered care to meet your unique needs.​​​​​​​

Need Assistance?

If you have questions about out-of-network billing, contact us or your insurance provider for more details. We’re happy to provide superbills (detailed invoices) to help you claim reimbursement from your insurance.

Disclaimer: The examples provided are estimates and actual reimbursement will depend on your insurance’s contracted rates and coverage. Please consult your insurance plan for final costs and coverage details.

WHAT’S COVERED DURING A ROUTINE PHYSICAL

The Basics

Most health insurance plans fully cover preventive care, including an annual general physical, without requiring you to pay a copay or deductible. This is part of the Affordable Care Act (ACA) requirement for preventive services.

Common services covered during a general physical include:

• Routine blood pressure, height, weight, and body mass index (BMI) checks.
• Routine vaccinations (flu shot, tetanus booster, etc.).
• Screenings for common conditions such as cholesterol, diabetes, and certain cancers.
• Counseling on healthy lifestyle choices.

Important Note: If you discuss new or ongoing health problems during your physical, those additional services may not be covered as part of the preventive visit, and you may have to pay a copay or coinsurance for them.

MEDICAL NECESSITY AND INSURANCE COVERAGE

Key Points

Health insurance companies often determine whether a service is covered based on whether it is considered “medically necessary.” This means that the treatment must be deemed essential to diagnose, treat, or prevent a medical condition.

Important Points About Medical Necessity:

• Varying Definitions: Different insurance plans may have different criteria for what they consider medically necessary. For example, some plans may only cover treatments like trigger point injections if they are done in conjunction with physical therapy.
• Service Limits: Even if a treatment is considered medically necessary, some insurance plans may impose limits. For instance, some plans may only cover a maximum of 4 trigger point injections per year.
• Denial of Coverage: If an insurance company does not consider a treatment medically necessary, they may deny coverage. In these cases, patients have the option to pay out-of-pocket (cash) for the service if they believe it will help improve their condition.
• Appealing a Denial: Patients can appeal an insurance company’s decision if they believe a service was wrongly denied based on medical necessity

HOW MEDICAL BILLING WORKS

Step 1: Receiving Services

When you visit a healthcare provider, the provider records the services they performed. This includes office visits, procedures, and any tests or screenings you received.

Step 2: Submitting a Claim

The healthcare provider submits a claim to your insurance company. The claim includes details of the services provided and their costs.

Step 3: Insurance Processes the Claim

Your insurance company reviews the claim to determine:

• Whether the services are covered under your plan.
• How much of the cost is covered by insurance.
• How much you are responsible for paying (e.g., copay, coinsurance, or deductible).

Step 4: Explanation of Benefits (EOB)

After processing the claim, your insurance company will send you an Explanation of Benefits (EOB). The EOB details:

• The services you received.
• The amount billed by the provider.
• The amount covered by your insurance.
• The amount you owe.

Important: The EOB is not a bill. It’s a statement explaining what your insurance paid and what you may need to pay.

Step 5: Paying Your Bill

If you owe any remaining amount after insurance (e.g., a copay, coinsurance, or because you haven’t met your deductible), the healthcare provider will send you a bill. Always compare the bill with the EOB to ensure accuracy before paying.

Out of Network Provider / Coverage

Out of network coverage varies, most PPO plans typically cover 50-80% of out of network providers. Assume your insurance covers 70% of the allowed amount after the deductible for out of network providers. Below is an example of what you might pay for a visit, depending on your insurance’s allowed amount, assuming you have met your deductible, and the allowed amount is equal to or greater than our fee schedule.

Service: New Patient (60 min)

• CPT Code: 99205
• Billed Amount: $250
• Allowed Amount Range: $300–$600+
• Insurance Covers (70%): $210–$420+
• You Pay After Deductible (30%): $75.00

Service: New Patient (30 min)

• CPT Code: 99203
• Billed Amount: $175
• Allowed Amount Range: $150–$300
• Insurance Covers (70%): $105–$210
• You Pay After Deductible (30%): $52.50

Service: Follow-Up (30 min)

• CPT Code: 99214
• Billed Amount: $175
• Allowed Amount Range: $150–$300
• Insurance Covers (70%): $105–$210
• You Pay After Deductible (30%): $52.50

Service: Follow-Up (20 min)

• CPT Code: 99213
• Billed Amount: $125
• Allowed Amount Range: $100–$200
• Insurance Covers (70%): $70–$140
• You Pay After Deductible (30%): $37.50

Service: Psychotherapy Add-On (16–30 min)

• CPT Code: 90833
• Billed Amount: $75
• Allowed Amount Range: $75–$150
• Insurance Covers (70%): $52.50–$105
• You Pay After Deductible (30%): $22.50

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Let’s say your insurance has a lower allowed amount for a level of service 99213, which is $100. At the time of your visit, you would be billed for the cost of the service. Afterwards you would be provided with a Superbill to submit to your insurance. Your insurance has an allowed amount for a 99213 of $100, and insurance covers 70% of the allowed amount, so you would be reimbursed from your insurance of $70. In this situation, your cost for that visit would of totaled $55.

One important factor to note is that medical billing for the level of service is based on the medical complexity of the evaluation. Determining medical complexity is quite complicated and involved, and a 20 minute appointment could easily be either a 99213 or a 99214 depending on the overall medical complexity involved. A simple and often accurate explanation is a 99213 is one stable medical issue that requires a prescription (simple medication refill for one condition). A 99214 is often appropriate for two stable medical conditions that require a prescription, or a chronic medical condition that is not adequately controlled (treatment adjustments etc) or exacerbated. Additionally, let’s say other factors of your health contribute to the medical decision making, this can contribute to medical complexity (typically in situations like these it will increase the medical complexity from a 99213 to a 99214. 99215 are rarely billed in medicine except for established patients where the time for all of the care for that day exceeds 40 minutes).

Unfortunately, health insurances keep their fee schedules and allowed amounts private and this information is not publicly accessible. The information regarding allowed amounts is an average from an internet search in the 90046 area, coupled with my experience in healthcare and ranges I have seen. Each plan has their own “allowed amount” rate of reimbursement for out of network providers, and this can vary largely between insurance plans.

In my experience, patients are often surprised at how economical out of network providers can be with their current health-insurance plan, and most folks have better outcomes and are happier with their healthcare if they connect with their provider, their provider cares about them, and has expertise in their unique health needs. From both my personal and professional experience in healthcare, the best outcomes / patient experience and the “cheapest care” are provided at different organizations.​​​​

TIPS FOR USING YOUR HEALTHCARE COVERAGE

In General

Understand Your Plan: Know your deductible, copay, coinsurance, and out-of-pocket maximum. This helps you anticipate costs.

Consider Value: Healthcare outcomes are incredibly important, you need a provider who is thorough, trustworthy, and are comfortable discussing any matter so you can make the best decisions for your health.

Keep Records: Save your EOBs and medical bills in case you need to dispute a charge.

Use Preventive Services: Take advantage of fully covered preventive services like annual physicals and vaccinations to maintain your health and avoid future medical costs.