2019 Financial Policy update
With the new year underway, we would like to share with you our Financial and Office Policies. These policies are designed to enhance our operating efficiency. Our providers and staff provide medical services for your children. All services provided are billable to your insurance and are subject to your insurance plan provisions. It is your responsiblity to understand your insurance policy.
Information regarding preventive exams
(also known as a “well check-up” or annual physical)
Pedicorp, PC recommends that our patients visit us each year for an annual physical exam or “check-up.” Children under the age of three need to be seen more frequently. Our annual exam visits are a wonderful opportunity for our physicians and nurse practitioner to perform a complete physical examination. During your annual exam, we will check and discuss your child’s health, growth, and development. It is also a time for us to:
Update family medical history
Review your child’s medical history & immunization status
Provide age-appropriate safety information & health education
Perform screenings in accordance with The American Academy of Pediatrics Bright Futures Guidelines* see our website or refer to the American Academy of Pediatrics Bright Futures website
When you bring your child for a yearly check-up, please let us know if you have had your child’s hearing or vision screened by a specialist so that we will not duplicate these important services.
During a preventive examination it is not uncommon for a second service to occur. The second service may be a follow up on a chronic health issue or a new problem that has occurred. This may be a medication check, mental or behavioral health concern, other ‘sick’ symptoms, or skin issues. Based on schedule availability the second service may be addressed along with the preventive service or another appointment may need to be scheduled. If the second service is addressed during a preventive exam, there may be additional charges depending on your insurance plan (i.e., a copayment, co-insurance, or deductible). Please consult with your insurer regarding your policy’s coverage.
FAQ'S (Frequently asked questions)
Do you take my insurance plan?
We are members of Integrated Care Partners, they assist us in all of our insurance company applications. We take many insurances, but within those insurances there may be specific plans that we are considered out of network. As the policyholder it is your responsibility to check with the plan to see how they will cover care your children will receive from our providers.
What are deductibles and how does that effect my children?
An annual deductible is the dollar amount you must pay out of pocket during the year for medical expenses before your insurance coverage begins to pay.
For example, if your policy has an individual deductible of $3,000.00, you must pay the first $3000.00 per individual family member before the insurance company starts to pay for any services.
This is similar to the deductibles with when you have a deductible for auto, home, or renter's plans insurance.
When does a deductible begin?
Your deductible begins at the start of your plan year. Most plan years begin either January 1 or July 1, but plans can start on any date.
Why is a financial update happening now?
January 1 is the date that most insurance plans 'reset' in terms of annual deductibles, and the date that many flexible spending account balances are refilled. With the changing environment in healthcare, in particular with the Affordable Care Act and the increase in Deductible Health Plans, more responsibility of payment for medical care is being placed on the patients. In order to continue to deliver the highest quality of care to your family, we as a practice and as a business needed to revise our financial procedures.
When do I have to pay for services?
Anytime you receive medical care, you are expected to pay all current and outstanding balances this may include balances for which you have not yet received a statement. You will be expected to pay all co-pays and a portion of the office visit deductible prior to the day's services.
How will I know when my deductible has been met and how much I will owe?
Health Insurance Companies provide the policyholder with an Explanation of Benefits (EOB), as well as online access to view your benefits. You can call your insurer, log onto the insurer's website, or receive mailed EOB's. Every time your child receives medical services, you will receive notification from the insurance company with how much they processed toward your responsibility about 10-20 days after your appointment has been billed.
Our practice reviews eligibility transmittals using the insurance information provided to us by you. From there we can see the if there is a deductible, co-payment, or co-insurance. If we see there is a deductible, we are collecting a portion at the time of the visit. We will bill you for any remaining charges beyond what is collected.
What we suggest
We suggest knowing your insurance plan. We understand that they can be confusing, but insurances have customer representatives who can help you understand your policy. Remember most employers offer health savings accounts, flexible spending accounts, and health reimbursement accounts that are meant for medical expenses.
Referrals are when a provider from our practice suggests that your child see a specialist,. Some insurance plans require a referral to be seen by another provider, if we have not suggested your child go to a specialist, we may ask that your schedule an appointment with our providers prior to referring your child out. All referrals must be requested PRIOR to your scheduled appointment with the specialist, we need a minimum of 48 insurance company business hours for us to initiate the referral, once initiated it is in the insurance companies hands, therefore, we cannot do anything further to expediate the referral. It is your responsibility to know your insurance plan and know if they REQUIRE a referral or prior authorization. Our providers may recommend you to a specific provider/practice/facility, but our practice does not know the specifics of your insurance, therefore, we suggest prior to making any appointments you check with your insurance to see if they REQUIRE a referral. Then contact our office and request a referral, we will need the name of the provider your child will be seeing, the address/phone number of the facility, and the date of the scheduled appointment. We suggest that 48 insurance company business hours prior to your appointment you verify that the referral has been received.
If you choose to seek services at an Urgent Care/Walk-in Facility, unless our office nurses or healthcare providers have REFERRED you, our practice will not fill out a referral.
We thank you for your continued patronage.
Most major insurance plans are accepted. It is your responsibility to verify with your insurer if our providers are in network with your specific plan. For example, our practice participates with Aetna but the Whole Health Network we are considered out of network. All balances must be satisfied PRIOR to preventative visits. Cash, personal checks, MC/Visa, Amer. Express, Discover, debit & credit are accepted for payment on all accounts.
- Aetna (NOT PREMIER CARE NETWORK PLUS-AETNA WHOLE HEALTH)
- Anthem Blue Cross/Blueshield (NOT BLUECARE PRIME)
- Harvard Pilgrim Health Care
- Health New England (not HMO)
- Private Health Care Systems (PHCS)
- T19/Husky (existinig patients only)
- Tricare (Prime members check with plan)
- United Healthcare
If you have a question regarding your specific plan please check with your insurance to see if our providers are in-network (there are so many select plans that have specific provisions it is best to go to the insurer). You may contact our Business Office if needed (860-231-8453).