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Insurance Information

Primary Care Falls Church participates with many popular insurance plans. For more information on the health plans accepted, call our office today. Remember, always check with your insurance provider to confirm your specific coverage and benefits.

Insurance cards are to be presented at the time of check-in prior to being seen. If a patient does not have their insurance card(s), they will be responsible for payment until such proof of insurance is provided.

Participating Plans

  • Aetna
    • All HMO, POS, PPO & EPO
    • AFSPA
    • Mail Handlers
  • Anthem BCBS
    • Excluding HealthKeepers Plus
  • BCBS Out of State Indemnity & PPO Plans
  • CareFirst BCBS
    • All HMO, POS, PPO & EPO
    • Federal Employee Program
    • FELRA
  • Cigna
    • HMO, POS, PPO, EPO & OAP
    • APWU
    • NALC
    • SAMBA
    • Connect
  • Coventry Health
  • First Health
  • Humana (Medicare only)
  • Innovation Health
    • Excluding Signature Plus plans
  • Kaiser Permanente Flexible Choice (with PHCS/Multiplan Logo)
  • Medicare
  • Multiplan
  • PHCS
  • Tricare / Humana Military
    • GEHA
    • Compass Rose
  • United Healthcare
    • Choice / Choice Plus
    • Select / Select Plus
    • Optimum Choice (OCI) / MDIPA
    • OneNet Workers Compensation
    • Navigate
    • Core / Core Essential
    • UnitedHealth One / Golden Rule
    • Medicare Advantage
    • Excluding Community Plan

Referral Policy

For those plans requiring referrals to specialty physicians, you must first receive authorization from  your designated primary care provider (PCP). To request a referral, please call the office at 703.532.5436 and choose the phone option for referrals.

There are certain guidelines that must be followed by this office as stated in the participating physician’s contract with your insurance company. You also have a responsibility to know your plan’s requirements and adhere to them. So that we may accommodate your requests and needs in an efficient and professional manner, please be aware of the following policy:

  • Request for referral must be authorized by you primary care physician
  • A minimum of 48-hours is needed for this office to process non-emergency referral requests. Emergency referrals will be handled as quickly as possible. It is the patient’s responsibility to make sure that they have complied with the referral policy guidelines of our office and have met the requirements of their health plan. The patient must have an approved and completed referral form or authorization number in hand PRIOR to examination by a specialist or testing performed. Referrals will not be faxed.
  • No retroactive referrals will be issued. If you are seen by a specialist or facility without the proper referral, your insurance carrier will most likely deny coverage and you will be responsible for charges incurred. If you receive treatment in a hospital emergency room or urgent care facility during a weekend, holiday or after hours, you must report this to our office on the first business day following, so we can provide proper authorization to that facility.

If you have any questions regarding the policy as stated above, please ask for clarification. Please take time to become familiar with your insurance policy and its requirements for obtaining referrals.

Instructions for Obtaining a Referral

  1. Select the specialist – contact your insurance carrier for a provider listing or ask our staff for assistance.
  2. Call the specialist’s office and make an appointment (be sure you give yourself at least 48 hours before the appointment so you can obtain a referral) – verify that the specialist does still accept your insurance plan.
  3. IMMEDIATELY call our office at (703) 532-5436 and select the option for the referral voice mail. Speaking slowly and clearly, leave the following information:
    • Your name and date of birth (please spell your last name).
    • A phone number where you can be reached or where a message can be left.
    • Name and phone number of the specialist you will be seeing (please give the address if you have it available).
    • The reason for your visit to the specialist, the date and time of your appointment.
    • Please state whether you will be picking up the referral from the front desk or if you prefer it mailed to your home.

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