At Horizons OB-GYN & Aesthetics, our experts are committed to making quality services accessible to all patients. We’re proud to offer a comprehensive list of insurance plans, including UMR, Advent Health, and Disney Health Insurance in Winter Garden.
But sometimes, navigating insurance coverage can feel overwhelming, especially where women’s health and aesthetics overlap. Without proper guidance, it can feel difficult to determine which treatments fall under insurance and which ones you have to pay for out-of-pocket.
Let’s clarify the basics of insurance coverage so you can feel financially secure and confident in your treatment decisions.
Insurance Coverage 101
Most health insurance plans cover essential healthcare services that are critical to maintaining your well-being. These policies protect you from unexpected and high medical costs. They also prioritize preventative care, including regular screenings and check-ups.
In short, if the care is medically necessary, it’s likely covered by insurance—but this depends on your specific plan and benefits.
Out-of-pocket expenses are costs that are not covered by insurance. This includes deductibles, or the amount you have to pay for covered health services before your insurance plan kicks in. You may also be responsible for copays, which is the fixed amount you have to pay for a covered service every time you go to the doctor or pick up a prescription.
There’s also an important distinction between in-network and out-of-network providers. An in-network provider has a partnership with your health insurance company. Your insurance company negotiates discounted rates with in-network providers, which usually means you pay less out-of-pocket.
Out-of-network providers don’t have this same agreement with your insurance company. This allows them to set their own prices that are often more expensive.
What Insurance Covers at an OB-GYN
Insurance covers most services on the women’s care side at Horizons. Regardless of whether you’re under Orlando Health, UMR, or Disney Health Insurance in Winter Garden, you can rest assured knowing that your most essential health services are likely built into your plan.
Preventative Care
Our well-woman exams are an essential and insurance-friendly form of preventative health care. These appointments help your provider learn more about your medical needs and create your personalized treatment plan.
Depending on the concerns identified during your well-woman exam, your provider may recommend one of the following tests or services:
- Pap smears
- STD testing and treatment
- Breast exams
- Birth control management
- Contraceptive counseling
Obstetrics
At Horizons, our team wants to support you through your pregnancy and beyond—and so does your insurance company. From advanced medical testing to postpartum care, we’ll be your trusted partners throughout your pregnancy journey.
Obstetric services include:
- Prenatal care
- Preconception counseling
- Ultrasounds and routine monitoring
- Genetic screenings
- Labor and deliver coordination
- Postpartum care
Gynecological Concerns
Gynecological concerns encompass a wide range of health conditions that affect the reproductive system. Examples typically covered by insurance companies like UMR and Disney health Insurance in Winter Garden include:
- Infections
- Abnormal bleeding
- Fibroids
- Endometriosis
- Ovarian cysts
- Menstrual disorders
- Polycystic ovary syndrome (PCOS)
Though some of these concerns may feel overwhelming or even frightening, you can approach treatment with courage and confidence knowing that most solutions are protected by insurance.
Where Insurance Stops
Though many of the essential services at Horizons are covered by insurance, that coverage typically does not extend to elective treatments.
Elective treatment options are non-essential services, or services that aren’t medically necessary. Though these procedures often improve a patient’s quality of life, they aren’t required for that patient to live.
Most aesthetic services aren’t covered by insurance. Despite creating beautiful results that help patients enhance their self-esteem, treatments like Botox, filler, and chemical peels are not classified as essential care.
Many of our wellness services are also elective treatments. Though these services can help you create the healthiest version of yourself, they often require out-of-pocket payments.
Financing
The experts at Horizons firmly believe that all patients should have access to the services they need—regardless of if they’re covered by insurance or require cash payments. We’re honored to offer patients a variety of financing options to make aesthetic and wellness treatments more affordable.
CareCredit
CareCredit is a healthcare credit card that helps patients finance the treatments they desire. It’s one of the best ways to pay for out-of-pocket costs while building credit.
Your CareCredit credit card can be used at over 285,000 practices nationwide—including Horizons. CareCredit breaks non-essential treatment bills into flexible payment plans, making quality care more accessible than ever.
The best part? CareCredit can be used to pay for services not fully covered by UMR, Orlando Health, and Disney Health Insurance in Winter Garden. That means you can combine your insurance benefits with CareCredit to make your care more affordable.
Cherry
Cherry breaks down your out-of-pocket expenses into fixed, cost-effective monthly installments. Our experts love Cherry because of its high approval rates, which are an ideal option for patients with less-than-perfect credit.
Though Cherry does involve a soft credit check, it does not impact your credit score. Cherry begins reporting your payment plan to the credit bureaus after 30 days, so you can pursue treatment with confidence.
Insurance Coverage Grey Areas
Insurance coverage isn’t always cut and dry—especially when it comes to treatments that could be deemed as both medically necessary and elective. Our experts are here to eliminate the guesswork from these confusing scenarios, so you can feel assured in your treatment decision.
Semaglutide
Semaglutide has helped countless patients reach their weight loss goals, but in most instances, these injections are not covered by insurance.
Insurance may cover semaglutide if it’s prescribed by a physician to help a patient treat weight-related health concerns, including diabetes and high-blood pressure. But when used for general weight loss in medical spa settings, semaglutide is almost always an out-of-pocket cost.
Hormone Replacement Therapy
Hormone replacement therapy (HRT) regulates age-related hormonal imbalances that cause disruptions to your routine. But even though these pills, patches, topical creams, and injections help you improve your overall quality of life, they are most often not covered by insurance.
Advent Health, UMR, and Disney Health Insurance in Winter Garden may cover HRT if it is prescribed to treat more intense symptoms related to menopause. We recommend consulting your Horizons provider to learn if your menopausal treatment needs may be covered by insurance.
Vaginal Rejuvenation
Most insurance companies do not cover treatments like Emfemme for vaginal rejuvenation, as they’re often used for aesthetic reasons or to enhance sexual function.
In some cases, pelvic floor therapy treatments like Emsella may be eligible for insurance coverage, especially if used to treat urinary incontinence. They may also cover vaginal rejuvenation treatments to address vaginal atrophy or laxity that causes pain during everyday activities.
Insurance Tips for Patients
You deserve to pursue care with confidence—not stress over insurance coverage and out-of-pocket costs. Our experts want to answer your questions so you feel confident moving forward in your treatment journey at Horizons.
Always Call Your Insurance Company Before Scheduling
Insurance coverage can vary widely from plan to plan, which can feel confusing if you’re unfamiliar with the details of your policy. Calling ahead gives you clarity on if your visit, test, or procedure is included in your benefits. It can also help you avoid surprise bills.
When you call your insurance company, we recommend asking:
- If Horizons is an in-network provider
- If your desired service is considered preventative or diagnostic
- What your co-pay or out-of-pocket responsibilities might look like.
This can give you peace of mind as you take the next step in your treatment journey.
Know Your Deductible and Out-Of-Pocket Maximum
Understanding your deductible and out-of-pocket maximum helps you plan for costs and make smarter decisions about when to schedule treatments. These numbers set the boundaries on how much you spend on healthcare in a year.
Be Proactive and Ask for a Cost Breakdown
When you visit Horizons, asking for a cost breakdown helps you understand exactly what’s billed to insurance and what’s your responsibility.
For example, insurance may cover a routine annual exam, but if you bring up a new health concern during your visit, it may be billed under an elective appointment, which could involve out-of-pocket costs. Seeing the difference between what’s covered and what’s elective creates a clearer picture.
Keep Records of Everything
Regardless of whether you’re covered by Orlando Health, Advent Health, or Disney Health Insurance in Winter Garden, save a copy of everything. This includes your insurance cards, explanation of benefits, receipts, and notes from phone calls with your insurance company.
Be sure to keep this information organized, too. This helps you double-check bills and even appeal denied claims by your insurance company.
Accessible Care at Horizons OB-GYN & Aesthetics
Though it can feel difficult to work through the intricacies of insurance coverage, the experts at Horizons serve as a guiding hand throughout the process. We’re proud to work with a variety of insurance networks to make your care more affordable, including UMR, Advent Health, and Disney Health in Winter Garden.
Clarity on coverage means peace of mind and better planning. Schedule your next visit online or give our team a call to learn what your policy covers.
Want to learn more about what coverage looks like at Horizons with Cigna Disney insurance? Our blog has additional details on the treatment possibilities with Disney Health Insurance plans.
