The Next Step in Quality Pediatric Health Care

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Insurance

As the child’s parent or guardian, you are responsible for all care rendered regardless of the level of your insurance coverage. Following are the most common varieties of ‘financial responsibility’. As mentioned, there are simply hundreds of different insurance plans and therefore it is the patient’s / member’s responsibility to know their own plan’s provisions in advance of each appointment.

Most plans require that you pay a copayment at the time of your visit, which is a fee paid at most visits. Copayment is collected upon checking in or out at your Care Center. Even though the Patient Protection and Affordable Care Act (or PPACA, also known as the ‘Health Care Reform Act’) has resulted in many plans being required to waive copays for well care, there are ‘grandfathered’ plans that require the continuation of copay collection at well visits. Also, in cases where a plan waives the copay for the well visit, it may require that we collect a copay on any other services rendered along with a well visit, such as a vision or hearing screening.

Some plans have a coinsurance provision, which means that the member shares in the total payment for services by paying a percentage of the total allowable (allowed payment or fee schedule) due to the practice. You will usually be balance-billed by us for that amount once your insurance company has processed the bill.

Many plans (and/or employers) now require that you meet a deductible amount, where the plan does not pay for any billed charges until the member pays a certain amount out-of-pocket for services within a given time period. For example, you may have an annual $2,000 deductible for your family, in which case your insurer will only start paying bills once you have paid $2,000 yourself for medical services.

Some insurers allow deductibles to be calculated in real-time, meaning that your insurer makes the remaining deductible amount available for look up online. In these cases, a portion of, or the remaining amount of that deductible (if equal or less than your visits charges), may be collected by us at the time of service.

If you have no insurance please see our Frequently Asked Questions page