Insurance
As a courtesy to our patients, we will gladly file the forms necessary so that you receive the full benefits of your medical coverage. We ask that you read your insurance policy to be fully aware of any limitations of the benefits provided. If your insurance company denies coverage, or we otherwise do not receive payment 60 days from filing your claim, the amount will then become due and payable by you. Remember that your coverage is a contract between you and your insurance company and/or your employer and your insurance company. Although we will make a good faith effort to assist you in obtaining your benefits, we cannot force your insurance company to pay for the services we have provided to you.
If your family is covered by two insurances (i.e. both parents work and both have insurance), the second insurance often does not pay the portion which the first insurance makes due from you (for example co-pay or co-insurance). Our policy is to collect the lesser of the two insurance’s patient obligations at the time of service. Again, after both insurances have addressed the claims, you may owe a small amount or show a small credit.
State law governs which insurance is primary and which is secondary, this is not a choice which you can make, nor one which we can make. Please check with both insurances if you are in doubt. You must disclose all insurances that cover your child(ren) at the time of service. Be aware of your insurance coverage. Some insurances do not cover well-child exams and immunizations and these services can be quite expensive. Feel free to discuss with us payment options and other options for immunizations if your coverage presents a problem.
It is your responsibility to understand your insurance coverage. Please call us as soon as possible if your insurance information changes. If we don’t have current information, claims may be denied and you will be held responsible for payment. Only custodial parents will be entered as responsible parties for minors despite divorce decrees or judgments. We are unable to become involved with these sensitive issues. If your account is past due and is sent to collections, your children may be terminated from the practice. We will make every effort to contact you before resorting to collections; please advise us of new phone numbers or address changes.
Copayments and Deductibles
Depending on your insurance policy, a copayment and/or deductible or coinsurance may be required at the time of service. Payment may be made in cash, by check or by credit card. We also accept Health Savings Account (HSA) cards for payment.Please note that the copayment is a contractual requirement from the insurance company and cannot be written off by the clinic. If you participate in a High Deductible Health Plan (HDHP) and have not yet paid your deductible in full, it is likely that any non-preventive services will require payment at the time those services are rendered. Coinsurance may apply even after meeting your deductible. Please see Health Insurance Decoded for a better explanation of these terms.
Patients Without Insurance Coverage/Non-Covered Expenses
We are happy to work with families that prefer to pay directly for services or do not have insurance. For such patients, a time of service discount will be applied to the bill if settled in full on the day of service. This discount does not apply after the day of the visit. The same discount will be applied to any non-covered charges for patients with insurance, if paid at the time of service. This discount can not be applied toward the “patient responsibility” portion of covered charges, as those charges are already discounted through the contract we maintain with your insurer.
Sick Complaints at a Well Child Check-Up
Please note that your insurance covers preventative care as a bundled service. If you present to a scheduled check-up and your child is sick, or you’d like to address a chronic issue, we are obligated to file a separate visit code with your insurance plan — just as we would if you brought your child in for that complaint on any other day. As such, your regular copay, deductible, and/or coinsurance amounts will apply and payment will be expected at the time of service.
TL;DR
Please understand:
- It is your responsibility to keep us updated with your correct insurance information. If the insurance company you designate is incorrect, you will be responsible for payment of the visit and to submit the charges to the correct plan for reimbursement.
- If we are your primary care physician, make sure our name or phone number appears on your card. If your insurance company has not yet been informed that we are your primary care physician, you may be financially responsible for your current visit.
- It is your responsibility to understand your benefit plan with regard to, for instance, covered services and participating laboratories. For example:
- Not all plans cover annual healthy (well) physicals, sports physicals, or hearing and vision screenings. If these are not covered, you will be responsible for payment.
- For children younger than 2 years, there is a limit as to the number of allowable well visits per year. If the number of visits is exceeded, your insurance company will not pay; you will be responsible for payment.
- It is your responsibility to know if a written referral or authorization is required to see specialists, whether preauthorization is required prior to a procedure, and what services are covered.
- According to your insurance plan, you are responsible for any and all co-payments, deductibles, and coinsurances.
- Co-payments are due at the time of service.
- Self-pay patients are expected to pay for services in FULL at the time of the visit.
- If we do not participate in your insurance plan, payment in full is expected from you at the time of your visit. We will supply you with an invoice that you can submit to your insurance for reimbursement.
- Patient balances are billed immediately on receipt of your insurance plan’s explanation of benefits. Your remittance is due within 10 business days of your receipt of your bill.
- Any balance outstanding longer than 90 days will be forwarded to a collection agency.
- For scheduled appointments, prior balances must be paid prior to the visit.
- We accept cash, checks, Amex, Visa, and MasterCard credit and debit.
- A $30 fee will be charged for any checks returned for insufficient funds.
