At Reform ABQ we understand that a Direct Primary Care Membership might not be for everyone so, have partnered with a few health insurance plans to offer Primary Care to you and your family. We currently do not accept Medicare or Medicaid.
Insurance VS Direct Primary Care?
When you choose to utilize commercial insurance we have to abide by the terms and conditions set forth by the insurance company and our office will function as a traditional primary care office for you and your family.
Reform ABQ will have to set forth the following rules:
No same-day or next-day appointment guarantee.
Access to the provider is limited to the office visit time and only through normal business hours.
No after-hour availability.
No access to the medication dispensing.
Telehealth will be limited by the terms of the insurance company.
Co-pay will be due at the time of service.
If we are unable to verify insurance eligibility your appointment will be rescheduled.
Accepted Insurance Plans
Contact our office if you have questions.
BAV - Blue Advantage HMO FEA - Federal Employee Program CNN - Blue Community HMO Network HMO - Health Maintenance Organization PPO - Preferred Provider Organization
UHC CORE HMO/CORE ESSENTIAL HMO UHC CORE ESSENTIAL EPO UHC CORE POS Choice HMO/Choice Plus HMO Choice EPO Choice Plus POS UHC NexusACO NR/NRB/NRP UHC NexusACO NR/NRB EPO UHC NexusACO NRP POS UHC NexusACO R/RB/RP HMO UHC NexusACO R/RB EPO UHC NexusACO RP POS UHC NexusACO OA/OAP HMO UHC NexusACO OA EPO UHC NexusACO OA POS UHC Doctors Plan/Plus POS UHC Doctors Plan EPO UHC Doctors Plan Plus POS Options PPO UHC Charter Plus UHC Charter Balanced UHC Charter Select/Select Plus HMO Select EPO Select Plus POS UHC Navigate Plus UHC Navigate Balance UHC Navigate
The Answers You Need
What is a deductible?
A deductible is an amount you pay for health care services before your health insurance begins to pay. Here’s how it works: If your health plan’s deductible is $1,500, you’ll pay 100 percent of eligible healthcare expenses until the bills total $1,500. After that, you share the cost with your plan by paying coinsurance.
What is co-insurance?
Coinsurance is your share of the costs of healthcare services after your deductible has been met. It's usually figured as a percentage of the amount the health insurance plan allows you to be charged for services. Here’s how it works: You’ve paid $1,500 in health care expenses and met your deductible. When you go to the doctor, instead of paying for all costs, you and your plan share the cost. For example, your coinsurance is 30 percent. Then your health plan pays 70 percent, and you are responsible for the remaining 30 percent of the costs.
What is a copay?
A copay is a fixed amount you pay for a health care service and is due at the time of service. The amount can vary by the type of service and your healthcare plan. Here’s how it works: Your health plan determines your copay for different services and when you have one. You may have a copay before you’ve finished paying toward your deductible. You may also have a copay after you pay your deductible and when you owe coinsurance.
What is prior authorization?
Prior authorization is an approval of coverage from your insurance company, not your provider. It’s a restriction put in place to determine whether your health plan will pay for certain medicines, procedures, diagnostic testing, etc. It doesn’t affect cash payments for these services.
Why aren't my medications prescribed covered by my health plan?
Health insurance plans have what is called a formulary list, which is their preferred list of medications, and often this list is to provide cost-effective medication for patients. However, the health plan can change this formulary annually and deny medications if they feel the safety profile is not proven or if they feel there is a better alternative. If your health insurance plan does not cover your medication, we can help you file an appeal. However, this does not mean that the health plan will cover the medication costs.