If patient has a Medicaid/State Funded insurance plan, they cannot be offered self-pay as another option.

If patient is self pay, please run Goodvisit to get the most up to date pricing and use the following verbiage:

"The self-pay fee will be collected at the time of service in the amount of $xxx.xx".

Goodvisit Link

Self Pay Codes:

 Arizona: 

  EXA Insurance Name: Self Pay-AZ  (20962)

 Nevada:

  EXA Insurance Name: Self Pay-NV  (20966)

  Southern California:

  EXA Insurance Name: Self Pay- SoCal (26278)

ONLY TO BE USED AT THE FOLLOWING SITES:

• Beverly Hills/Beverly Hills Olympic

• Carlsbad

• Encinitas

• Irvine

• Laguna Hills

• Redlands

• Riverside

• San Bernardino

• San Vincente

• Santa Ana

• Torrance

  Northern California:

 EXA Insurance Name: Self Pay- NorCal (20968)

ONY TO BE USED AT THE FOLLOWING SITES:

• Daly City

• Los Gatos

• Monterey

• Mountain View

• Redwood

• SFAMI

• SFMRC

• San Rafael

• Santa Clara

  Florida:

  EXA Insurance Name: Self Pay- FL  (20965)

  Colorado:

  EXA Insurance Name: Self Pay- CO  (23348)

 Texas:

  EXA Insurance Name: Self Pay- TX (25197)

  Kentucky:

  EXA Insurance Name: Self Pay- KY  (120037)

  New York:

   EXA Insurance Name: Self Pay- NY  (26557)

  Illinois:

  EXA Insurance Name: Self Pay- IL  (27390)

  Wisconsin:

  EXA Insurance Name: Self Pay- WI  (HCP15546IN)