Understanding Your Insurance
Understanding a few common insurance terms can help you plan for the cost of your care. Your exact benefits depend on your insurance plan.
Copays
A copay is a set dollar amount your plan requires for a covered service, such as $25 for an office visit. Whether a copay applies before or after you meet your deductible depends on your plan.
Deductibles
Your deductible is the amount you pay for certain covered services before your insurance begins sharing those costs. Some services, including eligible preventive care, may be covered before you meet your deductible. Check your plan’s benefits to see which services are subject to it.
Coinsurance
Coinsurance is your percentage of the insurance plan’s allowed amount for a covered service, generally after you have met any applicable deductible.
For example, if the allowed amount is $200 and your coinsurance is 20%, you would pay $40, and your insurance would pay $160. The allowed amount is the amount recognized by your insurance plan—not necessarily the provider’s original charge.
Out-of-Pocket Maximum
Your in-network out-of-pocket maximum limits how much you pay toward covered in-network services during your plan year. Once you reach that limit through eligible deductibles, copays, and coinsurance, your plan pays the covered in-network costs for the remainder of the plan year.
This does not mean every healthcare expense becomes free. Insurance premiums, non-covered services, and routine out-of-network charges do not count toward your in-network maximum.
Understanding Out-of-Network Benefits
Having insurance does not necessarily mean every physician participates in your plan. PPO plans generally allow you to see out-of-network providers, but your share of the cost may be higher.
Before relying on out-of-network reimbursement, ask your insurance company whether your plan covers the visit, whether a separate deductible applies, and what documentation you need to submit.
When appropriate, our office can provide a superbill documenting your visit for you to submit to your insurer. A superbill is not a guarantee of reimbursement. Your insurance company determines eligibility and payment under your plan.
Care Without Health Insurance
Patients without health insurance are welcome at Hennessay Medical.
With Personalized Primary Care (PPC), you pay a membership fee and pay separately for medical visits and other clinical services. With Direct Primary Care (DPC), routine primary care visits are included as described in your membership agreement.
Both options provide care from Dr. Hennessay—the difference is how your primary care is paid for.
Neither membership is health insurance. Hospital care, emergency services, and services from outside providers are not included in your membership. We encourage patients to maintain insurance coverage for healthcare needs beyond our practice.
Please see our Medical Services & Pricing page for self-pay service fees and the membership options above for enrollment pricing.
Using HSA or FSA Funds
Health Savings Account (HSA) and Flexible Spending Account (FSA) funds may be used for eligible medical expenses. Not every service or membership fee automatically qualifies. Check with your account administrator or tax advisor before using these funds for membership payments or other expenses.
Questions About Costs?
Our office can help explain our membership options, service fees, and billing documents. For confirmation of your coverage, network participation, deductible, or reimbursement benefits, please contact your insurance company directly.
To prevent catastrophic out-of-pocket costs, if you are uninsured, it is recommended to have a type of coverage plan that would cover you in the event of an emergency. You can get catastrophic coverage through the health insurance exchange. Health for California insurance brokers are a trusted resource to help you find a plan that fits your needs.
Insurance & Self-Pay for New Patients
Insurance We Accept
Hennessay Medical welcomes new patients with eligible Aetna PPO/EPO, Cigna PPO/EPO, and Curative PPO plans.
These are the only insurance plans we accept for new patients, but you may schedule a visit as a self-pay patient if you do not have one of the above plans. We do not accept PPO plans from other insurance companies, EPO, HMO, or POS plans. Medicare, Medicare Advantage, and Medi-Cal are not accepted.
Participation varies by specific plan and network. Please confirm with your insurance company that Dr. Megan Hennessay at Hennessay Medical is in network with your particular plan before scheduling.
Self-Pay is Welcome
Patients who are uninsured or have other commercial insurance may pay directly for visits at our published self-pay rates. We do not bill insurance for self-pay visits.
How Insurance & Membership Work Together
Our practice combines personalized primary care with a membership model. Your first consultation does not require membership. Membership is required for ongoing care after that first visit.
Personalized Primary Care (PPC)
Our Personalized Primary Care membership has the same age-based rate whether you use eligible in-network insurance or pay directly for medical services. Your insurance status determines how your medical visits are billed—not your membership rate.
With eligible in-network insurance: We bill your insurance for covered medical services. Copays, deductibles, and coinsurance apply according to your plan.
If we are out of network with your insurance or you are paying directly: You pay our published self-pay rates for medical services. When appropriate, we can provide a superbill for possible out-of-network reimbursement.
Membership fees cover the non-covered services and amenities described in your membership agreement. Medical visits and other clinical services are billed separately. Membership is not health insurance.
Personalized Primary Care (PPC) Membership Pricing
One membership, with the same age-based rates for new members whether you use eligible in-network insurance or pay directly for medical visits.
Ages 18–39
Monthly membership: $55
Initial six-month payment: $330
Annual prepayment: $605 (one month free)
Ages 40–64
Monthly membership: $75
Initial six-month payment: $450
Annual prepayment: $825 (one month free)
Ages 65+**
Monthly membership: $95
Initial six-month payment: $570
Annual prepayment: $1,045 (one month free)
How Membership Payments Work
Membership begins with a six-month initial commitment. With the monthly option, your first six months are paid upfront when you enroll. Monthly payments begin in month seven.
Prefer to pay annually? Receive 12 months of membership for the price of 11 when you pay for the year in advance.
These rates apply to new enrollments. This update does not change existing members’ membership rates.
Medical Visit & Service Pricing
PPC membership fees are separate from fees for medical visits and other clinical services. For covered services billed to eligible in-network insurance, your plan’s copays, deductibles, and coinsurance apply.
For self-pay pricing for consultations, follow-up visits, video appointments, annual physicals, and other services, visit our Medical Services & Pricing page.
Direct Primary Care (DPC)
For patients who prefer a more predictable, all-inclusive approach to primary care, we also offer a Direct Primary Care membership option.
With DPC, routine primary care visits are included in the membership fee rather than billed separately to insurance or paid for at each visit.
Ages 18–39
Monthly membership: $199
Initial six-month payment: $1,194
Annual prepayment: $2,189 (one month free)
Ages 40–64
Monthly membership: $249
Initial six-month payment: $1,494
Annual prepayment: $2,739 (one month free)
Ages 65+**
Monthly membership: $249
Initial six-month payment: $1,494
Annual prepayment: $2,739 (one month free)
DPC is designed for patients who prefer to pay directly for their primary care through a membership rather than use insurance for routine office visits. Insurance may still be used for outside services such as prescriptions, laboratory testing, imaging, specialist care, and hospital services.
A 6-month initial commitment is required for the monthly option.
**Why can’t you accept most patients age 65 and older?
Our practice does not accept Medicare. Federal regulations prohibit private, membership-based medical practices from contracting with Medicare beneficiaries for services covered by Medicare. To remain compliant, we are unable to accept most patients age 65 and older with any Medicare plan, even if they wish to pay privately.