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Know Your Benefits

Now more than ever, ongoing changes with health insurance plans make it especially important to understand your coverage and know the costs you must pay when visiting your physician, having tests, and undergoing procedures. For this reason, Summit Medical Group recommends that you learn the specifics of your plan before upcoming health care visits.

Your insurance plan may require multiple copays, higher deductibles, and coinsurance. Coverage will depend on the type of plan you have chosen. You can learn the details of your policy by visiting your insurance company’s web site or contacting its customer/member services department. The back of your insurance card should include the phone numbers and Web site addresses you’ll need.

Questions about your bill?

Summit Medical Group accounts representatives can answer your billing questions.

Call us: 908-790-6500
Email us: billing@smgnj.com
Monday through Friday, 7:30 AM to 6:00 PM.

Need a pricing estimate?

Rates vary widely depending upon your medical benefits and insurance plan. We may need to speak to you directly to determine your needs.

To start the process, either:

Call us: 908-790-6500
or Email us: estimates@smgnj.com
Monday through Friday,  7:30 AM to 6:00 PM.

Please be ready to provide as much of the following information as you can:  name, address, phone, procedure/service(s), CPT code (if available), insurance plan, contact info (phone number and/or email) and location of service(s), if known.

You will receive a good-faith estimate, which may include a typical range of costs for these services, within three business days.

Find the Right Medicare Plan for You

Summit Medical Group is partnering with the Medicare experts at Advise to help our patients understand the complexities of Medicare. Advise is a licensed Medicare agency that helps Medicare beneficiaries select, understand, and use their Medicare health insurance.

Advise offers a number of opportunities for Summit Medical Group patients to learn about their Medicare options through in-person and virtual seminars. To register for an upcoming seminar, click here.

Advise also provides individual consultations on plan options and answers questions about Medicare benefits. To schedule your complimentary consultation, call (908) 238-4341.

For more information about how Advise can help you find the right Medicare plan for your needs, call (908) 238-4341 or go to AdviseInsurance.com/SMG.

Looking for an overview of Medicare? Call (908) 238-4341 to request your FREE copy of Medicare 101: Your Complete Guide to Preparing for Medicare today!

Frequently Asked Billing Questions

Your statement looks different because as of August 13, 2019, CityMD and Summit Medical Group have merged to provide our patients with the high-quality care they already know, across a now wider range of primary, specialty, and urgent care services.

Summit Medical Group and CityMD participate in most insurance plans though some CityMD sites may not participate in all plans. Please check our websites listed below for a full list of participating insurances. We also recommend that you always verify location and physician participation with your health plan.

View a complete listing of Summit Medical Group accepted insurance plans

View a complete listing of CityMD accepted insurance plans

If you are calling regarding a Summit Medical Group balance you should call 908-790-6500.

If you are calling regarding a CityMD balance you should call 516-783-4600.

Summit Medical Group and CityMD participate in most insurance plans though some CityMD sites may not participate in all plans. Please check our websites listed below for a full list of participating insurances. We also recommend that you always verify location and physician participation with your health plan.

View a complete listing of Summit Medical Group accepted insurance plans

View a complete listing of CityMD accepted insurance plans

 

If you are choosing a health plan, review insurance plans and ask yourself:

  • What are my options?
  • Does this health plan provide the benefits and services I need?
  • Does this health plan offer the clinicians and hospitals I want?
  • Can I afford this health plan, including its premiums, deductibles, co-insurance, and copays?
  • Will the plan cover the cost of my medications?

You can learn details about your health insurance policy, including the amount of your copay, deductible, and coinsurance by visiting your health insurance company web site or calling its customer services department.

The back of your health insurance card should have the phone number(s) and website address(es) you need.

Before any health care visits, be sure to ask your health insurance company:

  • Is my doctor's visit covered completely? If not, how much must I pay?
  • Will my tests be covered completely? If not, how much must I pay?
  • If I need a procedure, including surgery, how much will my insurance cover? How much must I pay?
  • Will I need authorization from my insurance company before my health care visit?

To avoid unwanted health-care billing surprises, be sure to always:

  • Ask your insurance company what costs you must pay out of pocket for your doctor visit, health care visit, test, procedure, or surgery.
  • Bring your most up-to-date insurance card(s) to every doctor appointment and health care visit.

As of March 30. 2015, Summit Medical Group no longer accepts cash payments except at:

  • Berkeley Heights Dermatology
  • Berkeley Heights Plastic Surgery
  • New Jersey Physicians At Summit Medical Group services in Clifton

CityMD accepts cash payments at all locations

If you are injured in an automobile accident or at work, Summit Medical Group can help you get comprehensive, coordinated care for your medical needs.

In addition to our other services, we provide:

Summit Medical Group participates with most automobile insurance companies and managed care physician provider panels to help you get the high quality medical care to which you are entitled. We also participate with most workers' compensation insurance companies. 

To ensure authorized and timely care, our case coordinator can help schedule your appointments, expedite your treatment, and answer questions.

For more information or to schedule an appointment, please call us at 908-790-6578. If you need to send a fax, please dial 908-790-6581.

If you are injured in an automobile accident or at work, call your insurer first to confirm your coverage, get a claim number for the accident, and get the name of an adjuster.

For worker’s compensation, you must contact your insurer and obtain authorization before seeing a doctor or having any health care services or visits.

In an emergency, please visit our Urgent Care Center or the nearest emergency department.

Summit Medical Group offers a wide range of services to help you after an accident or injury, including: 

Summit Medical Group participates with most automobile insurance companies and managed care physician provider panels to help you get the high quality medical care to which you are entitled. We also participate with most workers' compensation insurance companies.

To ensure authorized and timely care, our coordinators can help schedule your appointments, expedite your treatment, and answer questions. For more information or to schedule an appointment with a case coordinator, please call us at 908-588-3905. If you must send a fax, please dial 908-790-6577.

Please contact your Affordable Care Act (Obamacare) insurer and ask for help understanding the details of your coverage.

Three New Jersey health care insurers offer plans aligned with the Affordable Care Act (also known as Obamacare), including:

Amerihealth

  • Summit Medical Group is in network for most Amerihealth plans offered through the Affordable Care Act marketplace / exchange
  • Summit Medical Group is not in network with the AmeriHealth Local Value plans, including the Local Value and Value Network plans
  • Summit Medical Group is not in network with Amerihealth NJ Tier 1 Advantage Silver EPO 
  • Please visit the Amerihealth website for more information

Horizon Blue Cross and Blue Shield of New Jersey

  • Summit Medical Group is in network with the Horizon Advantage EPO plan
  • Summit Medical Group is not in network with the Horizon Advance EPO
  • Please visit the Horizon website for more information

  • Copay is the fixed amount you must pay for a covered health care service. Copays are due at the time you receive a health care service. Most often, you will be asked to deliver your copay when you check in for your doctor's visit or diagnostic test. Copay amounts vary depending on your health insurance plan. For example, some patients will be required to copay $15 for a regular check up, whereas other patients might have a $20 (or a lower or higher) copay for the same appointment
  • Deductible is the amount you must pay for a health care service before your health insurance plan begins paying. For example, if you visit an emergency department and your deductible amount is $500, you must pay the $500 deductible amount before your insurance company will cover the remaining health care charges associated with your emergency visit. Deductibles do not always apply to all health care services. For this reason and to avoid unwanted billing surprises, you should ask your insurance company for a list of covered services
  • Coinsurance refers to your share of the costs of a health care visit. Coinsurance is calculated as a percentage of the amount of a service. You are responsible for paying the full amount of your coinsurance and your deductible charge. For example, if your health insurance plan allows $100 for a health care checkup and you have paid your deductible, your coinsurance payment of 20 percent (or whatever percent applies to your insurance plan) would be $20. Your health insurance plan will pay the remaining $80 due for your visit

Your health insurance company works with providers to agree upon a rate for a variety of health care costs. Once providers have agreements with your health insurance company, they are considered in network.

Your in-network providers can include:

  • Primary care doctors, other practitioners such as certified diabetes educators, nurse practitioners, physical therapists, and specialists
  • Laboratories
  • Radiology and imaging centers
  • Hospitals
  • Pharmacies

Health care providers in your network receive full payment from your insurance company for the agreed-upon rate for your health care services. The rate your providers receive includes your insurer’s share of the cost as well as your share of the cost. Most patients pay their share of health care costs in a copayment, deductible, or coinsurance.

For example, if a visit with your primary care doctor costs $120 and your agreed-upon copay is $20, you will pay $20 at the time you visit your in-network doctor. Your insurance company will then pay the agreed-upon balance of $100.

A doctor or practitioner, specialist, hospital, pharmacy, or other health care provider or service that has no agreement with your insurance company is considered out of network.

When you get out-of-network health care and services, you are likely to be responsible for paying some, much, or all of the cost of the service. The amount you must pay for out-of-network services depends on whether your health insurance company is willing to pay part of the bill. For this reason and to avoid unwanted billing surprises, it is best to check with your health insurance company before you get any out-of-network health care services.

In some cases, your health insurance company can give you a list of comparable, in-network health care providers and services. If your health insurance company cannot offer you an in-network alternative, you can ask a representative to tell you whether your health insurance company will cover any or all of the cost of the service you need.

Having your most up-to-date card(s) at each health care visit helps ensure that we have a valid group number, a valid mailing address for claims, updates for employer group renewals, changes in personal coverage options, and information about your visit such as workers compensation or motor vehicle accident information.

Call your health insurance company immediately if your insurance card is lost or stolen!

For referrals

  • If your primary care provider is with Summit Medical Group, you are responsible for knowing whether you need a referral for a health care visit outside of Summit Medical Group. Talk with your insurer before your health care visit to confirm whether it will be covered
  • If you have a non-Summit Medical Group primary care provider and your insurance plan requires a referral to see a Summit Medical Group practitioner, you must contact your primary care provider to get your referral before your health care visit

For authorizations

  • Authorizations are required for most services, tests, procedures, and surgeries
  • When your Summit Medical Group practitioner has ordered a service, test, procedure, or surgery for you, our authorization department will ensure you get the authorization you need; however, it is important that you follow up and confirm with your insurer and your provider that the authorization is in place before your health care visit

Talk with your insurer to clearly understand the details of your plan and coverage. You also can speak with a Summit Medical Group accounts representative or financial counselor Monday through Friday 7:30 AM to 6 PM to discuss your concerns and ask for guidance. Call us at 908-790-6500 or email us at billing@smgnj.com.

If you have no medical insurance, and need to discuss a balance for  Summit Medical Group you can speak with a Summit Medical Group accounts representative or financial counselor Monday through Friday 7:30 AM to 6 PM and ask for guidance. Call us at 908-790-6500 or email us at billing@smgnj.com.  If you need to discuss a balance for CityMD you can speak to a Customer Service Advocate at 516-783-4600.

To ensure that all the services you need are authorized and reimbursed appropriately, you must notify your provider as soon as you change insurance plans to give your provider the most current information about your new plan

Summit Medical Group accepts Medicare Advantage, including:

  • Aetna Medicare
  • Amerihealth Medicare
  • Clover Medicare
  • Humana Medicare
  • United Medicare

Summit Medical Group does not accept Medicaid.

Find the Right Medicare Plan for You

Summit Medical Group is partnering with the Medicare experts at Advise to help our patients understand the complexities of Medicare. Advise is a licensed Medicare agency that helps Medicare beneficiaries select, understand, and use their Medicare health insurance.

Advise offers a number of opportunities for Summit Medical Group patients to learn about their Medicare options through in-person and virtual seminars. To register for an upcoming seminar, click here.

Advise also provides individual consultations on plan options and answers questions about Medicare benefits. To schedule your complimentary consultation, call (908) 238-4341.  

For more information about how Advise can help you find the right Medicare plan for your needs, call (908) 238-4341 or go to AdviseInsurance.com/SMG.

Looking for an overview of Medicare? Call (908) 238-4341 to request your FREE copy of Medicare 101: Your Complete Guide to Preparing for Medicare today!

We want to help you!

Summit Medical Group accounts representatives and financial counselors can answer billing questions Monday through Friday 7:30 AM to 6 PM. Call us at 908-790-6500 or email us at billing@smgnj.com.

CityMD representatives can answer billing questions at 516-783-4600 or submitting an inquiry to https://www.citymd.com/about/contact-us 

You also may click here to register for our Summit Medical Group patient portal to manage your accounts, including seeing billing statements and balances and make secure credit card payments.

You can click here to register for our CityMD patient portal to manage your accounts, including seeing billing statements and balances and make secure credit card payments.