Billing and Insurance

 

We accept the following insurances:

  • Medicare Part B
  • PPO plans with out-of-network benefits
  • certain Medicare Advantage plans

The following insurance plans are not covered:

  • Managed care plans (eg: Affinity, Brand New Day, CareMore, Kaiser, Santa Clara Family Health Plan, and SCCIPA)
  • Worker’s Compensation
  • Car accident liens

As a courtesy, we check your coverage prior to scheduling and provide an overview of your coverage and the cost. However, since we are out-of-network with PPO plans, we do not have insight into how your plan might reimburse.

It is the patient’s responsibility to understand their insurance coverage. If you have questions after receiving our estimate, we encourage you to contact your insurance company.

  • We collect patient payments at the end of each visit. We accept credit card (Visa, MC, AMEX), personal checks, or cash.
  • Vortex submits claims to your insurance company for processing. Typically, you should expect receive the Explanation of Benefits (EOB) from your insurance company within 30-45 days after the claim is submitted.
  • If you have a balance due or we owe you a refund, we will mail you a statement.

If you have questions about your insurance coverage or payment obligations, please contact our office manager at (408) 540-7622.

Private Pay

Vortex offers a 20% discount (as of 1/01/2024) to those who do not have insurance coverage here or have a high deductible and prefer not to go through insurance. Please contact our office for more information.


Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.

• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.

• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call our number on our website for more information.

Insurance Coverage

We are Medicare providers and accept PPO plans with out-of-network benefits. We offer a discounted private pay rate to those without insurance coverage.

Please call if you would like our office manager to verify your insurance coverage.

Patient payments for deductibles, co-insurance, and supplies are collected at each visit.

Read More About Our Insurance and Billing Policy

Cancellations & No Shows

We have a 24 hour cancellation policy. If you do not provide adequate notice, we are unable to fill the appointment, which is a loss for us and for someone else waiting to come in. Please call ASAP to cancel or reschedule.

Vortex charges $75 for late cancellations; $100 for no shows. These fees are collected from the patient at the next scheduled appointment. Your insurance does not pay for missed appointments.

Need to cancel? Call Vortex now.

Learn More About Our Policy

For your convenience, our New Patient paperwork is available to download (PDF). Please download and complete the forms in advance of your first appointment.

Download Your New Patient Form