Billing & Insurance

Sound Family Medicine accepts most health insurance plans. Convenience is important, so we offer a number of ways in which bills can be reviewed and paid. We work to make it as simple as possible for you and your family.

List of Accepted Insurance Plans

We participate with the following healthcare plans. Please note this list does not guarantee coverage, and plans covered are subject to change. Eligibility and coverage may vary by plan and by service. Always check with your insurance company before scheduling an appointment.

Plans we accept

  • Aetna Choice POS II
  • Aetna Medicare Advantage (HMO and PPO)
  • Aetna Select
  • Aetna Signature Administrators® joint claims administration
  • Elect Choice
  • Managed Choice POS
  • National Advantage
  • Open Access Student MC
  • Passport to Healthcare®
  • Preferred (PPO)
  • QPOS
  • Open Access Plus (OAP)
  • Preferred (PPO)
  • Humana Medicare Advantage (HMO and PPO)

Kaiser Permanente Access PPO

  • United Health Community Plan – established and new OB patients only
  • Original Medicare
  • Medicare Part B Supplemental Plans A – N and those provided by employer retirement plans

Accepting new patients with the following Medicare Advantage plans:

  • Aetna Medicare Advantage (HMO and PPO)
  • Humana Medicare Advantage (HMO and PPO)
  • Premera Medicare Advantage (HMO)
  • Regence Medicare Advantage (PPO)
  • United HealthCare Medicare Advantage (Medicare Complete HMO)
  • Global
  • Heritage
  • Heritage and Dental Choice
  • Heritage Prime
  • Heritage Signature
  • Heritage Signature and Dental Choice
  • Individual Signature
  • LifeWise Assurance Co.
  • LifeWise Health Plan of Washington Preferred
  • LifeWise Primary
  • Premera Medicare Advantage (HMO)

Please contact Premera to verify your coverage if your insurance plan is not listed above.

  • Participating (PAR)
  • Preferred (PPO)
  • Real Value Network
  • Regence Medicare Advantage (HMP and PPO)
  • SelectMed
  • Uniform Medical Plan (UMP)
  • WA Individual and Family

Please contact Regence to verify your coverage if your insurance plan is not listed above.

  • Kaiser Permanente WA Options, Inc.
    • Access PPO
  • Premera
    • Premera High PPO
    • Premera Standard PPO
  • Uniform Medical Plan (UMP), administered by Regence BlueShield
    • UMP Achieve 1
    • UMP Achieve 2
    • UMP High Deductible
    • UMP Plus – Puget Sound High Value Network
  • Choice EPO
  • Choice HMO
  • Choice Plus POS
  • Nexus ACO
  • Preferred (PPO)
  • Select EPO
  • Select HMO/Select Plus
  • Select Plus POS
  • UHC Charter EPO
  • UHC Charter HMO
  • UHC Charter POS
  • UHC Core Choice Plus POS
  • UHC Core EPO
  • UHC Core HMO
  • United HealthCare Medicare Advantage (Medicare Complete HMO)

Other Insurance Information

Effective January 1, 2018, Sound Family Medicine will no longer be contracted with the Department of Labor & Industries.

Sound Family Medicine will no longer be able to care for any workplace injuries for L&I or a self-insured employer.

We understand that the relationship you have with your provider is important. You can continue care with your primary care provider for other health concerns not relating to your L&I case. For L&I, we will refer you to one of the following organizations:

Concentra Urgent Care (formerly Puyallup US HealthWorks)  (253) 840-1840

Archie Adams, MD at MultiCare Occupational Medicine (888) 280-5513

MultiCare Referral Line (800) 342-9919

We accept motor vehicle accident claims for existing patients only.

If you have Personal Injury Protection (PIP) coverage and your account with Sound Family Medicine is in good standing, your auto insurance carrier will be billed for your visit.

If your insurance policy doesn’t have PIP coverage, we are unable to bill your health insurance until we can verify that you have set up subrogation with them for any medical care provided as a result of a motor vehicle accident.

If the other driver is at fault, Sound Family Medicine does not bill auto insurance claims to third parties (other driver’s MVA insurance).

Payment for these visits is due at the time of service or we can bill to your commercial medical insurance if we can verify you have set up subrogation (the assumption by a third party, an insurance company, of another’s legal right to collect a debt or damages).

The School Employees Benefits Board (SEBB) Program will administer health insurance and other benefits for eligible school employees and their dependents, coverage beginning January 1, 2020.

Sound Family Medicine is in the network of the following plans:

  • Uniform Medical Plan (UMP), administered by Regence BlueShield
    • UMP Achieve 1
    • UMP Achieve 2
    • UMP High Deductible
    • UMP Plus – Puget Sound High Value Network
  • Kaiser Permanente WA Options, Inc.
    • Access PPO
  • Premera
    • Premera High PPO
    • Premera Standard PPO

Payment Services

Payment or authorization to bill your insurance carrier for services rendered is due at the time of service. If you have an outstanding balance, payment will be requested at check in.

We understand that sometimes, unexpected circumstances impact how and when you are able to pay for your healthcare services. Below, you will find detailed information on our payment options and billing scenarios.

If you have further questions, or need financial assistance, don’t hesitate to call us at 253-848-5951.

Payment can be made via any of the following methods:

Online bill pay via the mySFM patient portal

Our automated bill pay phone line is available 24/7. Just call 844-296-3015. Please have your account number (located in the upper right corner of your statement) and your bankcard number ready.

In person at any of our clinics

If you are uninsured, you may participate in Prompt Pay, a medical discount program.

Through Prompt Pay, patients who pay in full at the time of service are able to take advantage of discounted pricing. Patients are charged a flat fee of $95.00 per visit, payable by cash or debit/credit card. Checks are not accepted in this program.

Should your visit be more complex and require significantly more time than an average visit, your provider may charge an additional $20.00 at his/her discretion.

Any additional services, such as laboratory tests, will be charged in addition to the visit fee.

Your insurance policy is a contract between you and your carrier; it is important that you read and fully understand your benefits. If you aren’t sure, please do not assume your policy covers every form of medical care. Policies and benefits differ, even those from the same carrier.

Ultimately, it is your responsibility as the patient, to understand what is/is not covered by your insurance policy.

Always carry your insurance card with you. Not only might you need it in an emergency, but we will also need it to verify your coverage at each office visit. Without this information, you may be asked to reschedule your appointment, or pay for services out of pocket at the time of your visit.

Your personal financial responsibility for co-pays, deductibles and non-covered services are mandated by your health plan. Sound Family Medicine is contractually obligated to collect these fees, and we are not permitted to adjust these costs to your account.

Copayments are a part of your insurance contract and are due at the time of service. Please have your copayment ready for when you check in for your appointment. If you are unable to pay your copay, you may be required to reschedule your visit.

If you have an unmet deductible remaining in your plan year, we require a $95 deposit on the unmet deductible at time of check in.

Payment arrangements for past due balances can be made with our billing department at 253-848-5951 and select option 4.

If payment is not made within the agreed-upon time period, the account will be turned over to a professional collection agency.

At that time, the patient and family may be discharged from Sound Family Medicine. Please contact us as soon as you know you are unable to pay your bill, so that we can proactively make payment arrangements with you.

 In the event that a check is returned NSF, there will be a $30 NSF charge applied to the patient’s account, in addition to the amount of the returned check.

What is Prior Authorization?

This is an insurance process on obtaining approval from your insurance company for certain procedures, services, or medications. This process must be completed prior to scheduling certain appointments/procedures or obtaining medication.

What is a copay?

This is the fixed dollar amount a patient pays for covered health care.

What is coinsurance?

Patient share of the costs of a covered service, calculated as a percent of the allowed amount for the service. Example: If the plan’s allowed amount for an office visit is $100, patient co-insurance payment of 20% would be $20.00.

What is a deductible?

A deductible is the amount you must pay for covered services before the insurance starts covering your cost. Screenings, immunizations and preventative services are covered without requiring you to pay a deductible. If you are unsure of your coverage, please contact your insurance company.

What is an out-of-pocket limit?

This is the most you could pay during a covered period (usually 1 year) for your share of covered services. If you are unsure of your limit, please contact your insurance company with questions.

What does in-network mean?

“Participating” or “In-Network” providers are those contracted with your insurance carrier. You pay a lower co-insurance and deductible when they use an in-network provider.

What does out-of-network?

If a provider or pharmacy is not listed as an “in-network” or “participating provider”, you will have a higher out of pocket cost for the service(s) rendered. Please contact the customer service number on the back of your card for the exact amount. The deductible and co-insurance will be higher than in network providers.