Insurance and pricing

All billing questions can be directed to 908-790-6500 or emailed to:

Summit inquiries: billing@summithealth.com
CityMD: billing@citymd.net

Summit Health 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 Health 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 type of health coverage is right for me?
• What benefits are included?
• Is my medicine covered, and how much will it cost?
• Will I be able to use my current doctors and hospitals?
• What happens when I'm away from home?
• Can I afford this health plan, including its premiums, deductibles, co-insurance, and copays?
• What will I pay for services I use often?
• Do I qualify for financial help?

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.

Yes, we accept cash payments at all sites.

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

In addition to our other services, we provide:

• Expert physicians in a wide range of specialties
• A state-of-the-art laboratory
• Imaging/radiology services
• Physical therapy

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

• Expert physicians in a wide range of specialties
• A state-of-the-art laboratory
• Imaging/radiology services
• Physical therapy

Summit Health 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 (ACA) insurer and ask for help understanding the details of your coverage.

Summit Health is in network with the following ACA insurance carriers:

• Aetna
• Amerihealth
• Horizon BCBS
• Oscar Health Plan

• 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 Health, you are responsible for knowing whether you need a referral for a health care visit outside of Summit Health. Talk with your insurer before your health care visit to confirm whether it will be covered
• If you have a non-Summit Health primary care provider and your insurance plan requires a referral to see a Summit Health 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 Health 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 Health 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@summithealth.com.

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 Health accepts traditional Medicare and some Medicare Advantage plans.

Summit Health does not accept traditional Medicaid, however we are in-network with some Medicaid Advantage plans.

View a complete listing of Summit Health accepted insurance plans.

View a complete listing of CityMD accepted insurance plans.

Find the Right Medicare Plan for You

New to Medicare or have questions about your options? It can be confusing. And finding the right Medicare plan for your individual needs is important.

That’s why we’re partnered with HealthShare360, an unbiased local resource who specializes in Medicare. They can help you compare your coverage options and select what works best for you.

Through our partnership, HealthShare360 offers you the ability to view, compare and get an estimate for Medicare plans that include Summit Health and Summit Health-affiliated doctors.

To learn more, visit HealthShare360:

New Jersey residents     Westmed patients     Oregon residents

HealthShare360 Inc. is a licensed and certified health insurance agency that works with Medicare enrollees to explain Medicare Advantage, Medicare Supplement Insurance, and Prescription Drug Plan options with a Medicare contract.  Enrollment in any Medicare plan depends upon contract renewal. For a complete listing of available Medicare plans, please contact 1-800-Medicare (TTY users should call 1-877-486-2048), 24 hours a day/ 7 days a week or consult www.Medicare.gov.

We want to help you!

Summit Health and CityMD 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:

Summit inquiries: billing@summithealth.com
CityMD: billing@citymd.net