Pricing, Insurance & Membership Options
Affordable, Accessible Healthcare in California & Alaska
Health Insurance & Coverage Details
Insurance & Private Pay
We are in-network with select insurance plans, but availability varies by state and by whether you are a new or established patient.
Alaska
We continue to accept insurance for eligible Alaska patients, including Alaska Medicaid, Aetna Cigna PPO, and Moda Health (Moda Select, Connexus, Endeavor Select, Pioneer, Tier 1).
California
Be Well Medical Group is currently not accepting new California patients through commercial insurance plans. New California patients are currently accepted on a private-pay basis only.
Established California patients who are already using insurance may continue care as scheduled.
California insurance status: We have existing contracts with Aetna PPO, Cigna PPO, UnitedHealthcare, Optum, and Medicare Part B FFS. However, we are not currently opening new California insurance-based patient slots while we review long-term insurance participation.
If we are not in-network with your plan, or if you are seeing us privately, we can provide a superbill for potential out-of-network reimbursement.
CASH PAY PRICING
Start Here: New Patient Visit
$300–$400
Your first visit includes a comprehensive evaluation and a personalized care plan tailored to your needs.
Visit length: 40–60 minutes, depending on complexity.
No commitment is required. After your first visit, you can choose the care option that works best for you.
Choose Your Care Option
Pay-Per-Visit
No membership required
This is the best option for patients who need occasional care, periodic follow-up, or help with a specific concern.
Initial visit: $300–$400
Follow-up visits: $200
Best for:
one-time concerns
periodic medication management
stable chronic conditions
patients who do not need monthly visits
patients who prefer flexibility
Many patients do well with follow-up visits every few months once their care plan is stable.
Membership Care
$150/month
Membership care is available for established patients who need more consistent support and ongoing medical management.
This option may be helpful for patients who benefit from regular follow-up, care coordination, and closer monitoring.
Includes:
routine follow-up visits
chronic condition management
medication management and adjustments
hormone therapy support
weight loss follow-up
preventive care and general health support
access to discounted lab and imaging rates
Membership is best for patients who need regular, ongoing care — not for patients who only need occasional visits.
Additional visits or extended visits may have added costs depending on complexity and time required.
Important Membership Notes
Membership plans are not insurance and do not replace health insurance coverage.
Membership cannot be used together with insurance billing. Due to federal regulations and insurance contract restrictions, membership services are not available to Medicare patients or to patients whose insurance plan we are contracted with.
Medications are filled separately through pharmacies.
Addiction Care Notice
Medication-assisted treatment and addiction care, including treatment for opioid use disorder or alcohol use disorder, are not eligible for membership pricing.
These services are offered through a separate care structure because they often require additional monitoring, visit frequency, refill coordination, safety planning, documentation, and clinical oversight.
Patients seeking addiction care may still be seen on a private-pay or insurance basis when appropriate.
ADHD Care Notice
Due to the time-intensive nature of ADHD evaluations, initial ADHD evaluations are not included in membership.
Initial ADHD Evaluation: $700
This includes an extended evaluation. ADHD is typically diagnosed over more than one visit when clinically appropriate.
Follow-up ADHD visits may be available through pay-per-visit or membership, depending on clinical needs, visit length, and monitoring requirements.
New Patient Visit - 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.
New Patient Visit - 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
Follow-Up Visit ($200)
Established patient visit, typically 20–30 minutes, for ongoing care, medication management, lab review, chronic condition follow-up, hormone therapy follow-up, or mental health follow-up.
ADHD Consult / (CA: $700)
A formal ADHD diagnosis requires at least two appointments. This initial consult includes a 90-minute evaluation and over 30 minutes of documentation review and charting. The total cost for this first visit is $700 for cash-based or out-of-network clients. I can provide a superbill for you to submit to your insurance.
Due to the time-intensive nature of this visit, the initial ADHD consult is not eligible for our $150 monthly membership plan. However, follow-up appointments may be eligible for the membership or can be paid per visit.
PRP Injections
Clinic: $500
PRP for two people: $800
PRP Bundle: Four sets of injections $1600 (must use within 12 months, $400 discount)
Trigger Point Injections
$200 injection fee
Labs & Diagnostic Pricing
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
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.
Conveniently Schedule Online
Contact our office and a staff member will be happy to assist you.