We believe access to excellent healthcare is a basic human right.
We do not believe that insurance coverage should dictate care
or prevent anyone from being their best healthy self.
We will work with you to provide what you need.
Please do not hesitate to contact us if you do not have insurance
as we have options available.
Health insurance is unnecessarily (and purposefully) complicated, so it is no wonder people don’t understand how it works. It is the only American industry that can legally take customers money and decide they won’t provide a product or service in return, or at least, do it only on THEIR terms.
How does the American health insurance system work?
The basic idea is that health insurance helps Americans pay for medical care — like doctor visits, prescriptions, surgeries, or hospital stays. Instead of paying the full cost every time a patient sees a medical provider, patients with insurance pay a monthly fee (called a PREMIUM) to an insurance company. In return, the insurance company agrees to cover part (or most) of the medical bills. Patients share the cost - having to also pay a DEDUCTIBLE (the amount the patient must pay before insurance will pay anything), a COPAY (a fixed amount per visit), and COINSURANCE (a percentage of the bill the patient is responsible for after meeting the deductible). Some insurance companies have an OUT-OF-POCKET maximum which caps how much the patient can be charged in a year and then insurance covers the rest.
What is the “network”?
An insurance company creates a network of providers who agree to charge a designated amount for services.
If a patient goes to a provider in-network, the insurance company will pay most or all of the bill.
If a patient goes to a provider out-of-network, the insurance company will decide how much of the bill they are willing to pay (which could be nothing), and then the patient is responsible for the balance.
Is Form & Function Healthcare in my network?
We are attempting to join every insurance company network out there, but they have the power in this scenario and call the shots. We are updating this page as we get confirmation from insurance companies. It helps if you call your insurance company and request Form and Function Healthcare and Jennifer Bell, APRN-CNP be added to their network.
So what happens if Form & Function is not in-network and I make an appointment?
We will see you for your first appointment, and then we will bill your insurance company as an “out-of-network” provider. At their discretion, they may pay us the full amount billed, may pay some of the bill, or may deny the bill entirely. If they pay the full amount, that is fantastic! If they pay at least $100 of the bill, we will accept that as paid in full. If they do not pay at least $100 or pay us nothing at all, you will be billed for the remainder up to $100. We will continue to contract with all insurance companies and hope that eventually, they will accept us in-network. It helps if you call your insurance and request that they contact with us.
If we are not yet “in-network” with your insurance provider,
we can still bill them “out-of-network” for the first visit and continue our attempts to contract with them for future visits.
√ Ohio Medicaid
We are proud to accept all State of Ohio Traditional Medicaid plans.
√ Ohio Medicare
We are proud to accept Medicare.
X Aetna
We asked Aetna to be in network, and they denied us stating that they have “too many primary care nurse practitioners.” We have learned that they are in talks to merge with another company and are not starting any new contracts at this time.
This means that Form & Function will be out-of-network. We will attempt to bill them, or, Aetna patients can pay out of pocket and submit for reimbursement from Aetna.
√ Anthem Blue Cross and Blue Shield (“Anthem”)
We have been accepted by their TRADITIONAL product as well as the following managed care plans (Medicaid):
Blue Access
Blue Access OH I (Tier I Provider)
Blue Access OH II (Tier I Provider)
Blue Preferred
Pathway Tiered Hospital Pathway X Tiered Hospital (Exchange PPO)
Pathway Group
Medicare Advantage HMO and PPO
√ Buckeye Health Plan
√ Caresource
√ Medical Mutual
√ Molina
X OSCAR
We have applied with OSCAR and are awaiting an answer. It is important to us that we contract with this company as we know that very few providers and hospitals accept this insurance.
X OSU Healthplan
We asked OSU Healthplan to contract with them, and they denied us on our first attempt. We will continue to apply.
If you have an OSU Healthplan, please call them and request Form and Function Healthcare and Jennifer Bell, APRN-CNP be added to their network.
We will bill out-of-network. At this time, if they pay at least $100 of the bill, we will accept that as paid in full. If they do not pay at least $100 or pay us nothing at all, you will be billed for the remainder up to $100.