Health insurance exchange (i.e., Obamacare exchange, ACA exchange)
Many of our patients have inquired about which plans Sensenbrenner Primary Care will participate with that are being offered on the health insurance exchange. Patients wishing to shop for health insurance through the exchange will need to visit https://www.healthcare.gov/.
For 2017/2018, North Carolina residents have one insurance company option on the exchange, BCBS. In the Charlotte region, specifically Mecklenburg County, there are two BCBS plans to choose from, Blue Local w/ CHS and Blue Value. Both are limited network plans. We attempted, without success, to gain access to the Blue Value network on more than one occasion. Unfortunately, we remain out of network with both plans.
South Carolina residents can choose variations of a plan “Blue Essentials” that is also a limited network plan. We are out of network with Blue Essentials.
*If you choose Blue Value, Blue Local w/ CHS or Blue Essentials and want to keep Sensenbrenner Primary Care as your PCP, we will file a claim to BCBS on your behalf. Understand that your benefits level will be reduced, if there are any benefits at all. Please refer to your plan documents or contact the customer service number on the back of your card with specific questions regarding how your claim might be processed.
Sensenbrenner Primary Care is a participating provider for TRADITIONAL Medicare (Part B) ONLY. We are not in-network any Medicare Advantage Plans (Part C, or ‘MA’). Medicare Advantage plans are sold by many companies and go by many different names. Please ask us if we participate before you switch. Some different types of Medicare Advantage Plan are as follows:
Health Maintenance Organization (HMO) Plans: In HMO plans, you generally must get your care and services from doctors, other health care providers, or hospitals in the plan’s network (except emergency care, out-of-area urgent care, or out-of-area dialysis). In some plans, you may be able to go out-of-network for certain services, usually for a higher cost. This is called an HMO with a point-of-service (POS) option.
Preferred Provider Organization (PPO) Plans: Generally, you can get your health care from any doctor, other health care provider, or hospital in a PPO’s network. You can also go to doctors, other health care providers, or hospitals that aren’t in the plan’s network, but it usually costs more.
Private Fee‑for‑Service (PFFS) Plans: If you join a PFFS plan that has a network, you can see any of the network providers who have agreed to treat you. You can also choose an out-of-network doctor, other health care provider, or hospital that accepts the plan’s terms, but it may cost more. If you join a PFFS plan that doesn’t have a network, you can go to any Medicare-approved doctor, other health care provider, or hospital that accepts the plan’s payment terms and agrees to treat you. Not all providers will.
If you choose a Medicare Advantage Plan and want to keep Sensenbrenner Primary Care as your PCP, a claim will be filed to your Advantage plan on your behalf. If you have chosen a plan other than PFFS, your benefits level may be reduced and your out of pocket expense may be more.
Cigna, Cigna/Great West
BCBS NC Blue Advantage (PPO)
BCBS NC Blue Care (HMO)
BCBS NC Blue Classic (Comprehensive Major Medical CMM)
BCBS NC Blue Options, Blue Options HSA (a traditional PPO)
BCBS NC Blue Select (tiered PPO w/ two levels of in-network benefits)
BCBS NC State Employees Health Plan
BCBS SC Preferred Blue
BCBS SC State Health Plan (SHP)
BCBS SC Blue Choice
BlueCard PPO Basic
or if your card says PPO inside of a suitcase
Use this website to see if we are a network provider using the alpha prefix from your BCBS card (BCBS provider search). Be sure to enter our zip code, 28277 and the alpha prefix from your card for accurate results!!
Self-Pay (no insurance)
We do accept self-pay patients. Payment in full is expected at the time services are rendered. Upon checking in at the front desk, you will be expected to pay a $100.00 pre-payment. At check-out, the provider will indicate what services were rendered and the balance of your visit is due prior to leaving. If the services total less than $100.00, you will be refunded the difference.