The Next Step in Quality Pediatric Health Care

Call Us: (201) 252-8700  •  Fax: (201) 252-8701

Frequently Asked Questions

Insurance Plans

I have insurance, but I do not participate with your plan?

We expect that you will make payment at the time of service, at which time we will provide you with a receipt that can be submitted by you to your insurer for direct reimbursement. Many insurers will pay only up to their ‘allowable’ amount for any given service, and as such, it may be less than what our charges are for those services. We therefore offer a 40% time of service payment discount to help offset some of that cost for you. In the event that a reimbursement payment comes directly to us, we will forward that payment to you promptly.

I do not have insurance?

We will work with you to make sure that your child receives the care they need. This often starts with a 40% discount for payment at the time of service. Your child may also qualify for free vaccines under the State’s Vaccines For Children (VFC) Program. Also, you will only be charged the Medicaid allowable for vaccine administration costs (currently $24.00).

In addition, you may qualify for one of the State Medicaid plans. For further information please see the NJ FamilyCare web site.

Do you offer payment plans?

Please do not hesitate to call our billing team at (201) 252-8700 if you need to set up a payment plan to pay charges over time.

How do I plan a visit with my HMO Plan?

Many HMO plans require you to select a Primary Care Provider (or PCP). You must do so in order for services rendered by us to be covered by your insurer. If your dependent’s insurance card does not list a PCP, or lists a PCP other than a provider here at our practice, you must call your insurer and ask them to assign your child to one of our providers BEFORE your visit. This will ensure that you avoid liability for charges for that visit.

How do you handle referrals with my insurance plan?

Insurance regulations prevent us from making referrals to specialists unless your child has been seen by us for the specific problem. We cannot make ‘retroactive’ referrals (meaning dating them prior to your request for one). For any new referral requests, please call our office and schedule an appointment so that we may evaluate the issue and make recommendations from there. You may not need to be seen for follow-up referrals (for example, if the specialist is providing on-going care and another X number of visits need to be authorized). In those cases, please call our office with details and allow at least 3 business days for processing.

I have both primary and secondary insurance?

Sometimes the primary insurer submits the balance to a secondary insurer after they have processed their part of the bill. If your insurer does not provide that service, and we only participate with the primary insurer, you will need to make prompt payment to us on any portion of the charges that your primary carrier does not pay. We will provide you with a bill which can be submitted to your secondary carrier along with the explanation of benefits that you receive directly from the primary carrier, in order for you to be reimbursed by the secondary for any benefits due to you.

Who do I see about my benefits?

We have a centralized billing team that can handle all of your questions. Please call (201) 252-8700 during normal business hours for assistance. If you receive a statement or explanation of benefits from your insurer, please refer those inquiries directly to member services at your plan.

How do you handle billing for a non-custodial parent?

Our policy is that the parent or guardian who brings the patient in for his/her care is financially responsible for the charges incurred at that visit. Divorce agreements and arrangements are strictly between the parents and we are unable to split bills or have two different financially responsible parties on the patient’s account.

What happens if I can’t meet my financial obligations?

We understand that sometimes it can be difficult to meet financial obligations. We will hold accounts for 120 days before sending them out for collection by an outside agency. If you are unable to pay your bill within that time period, please help us to help you and call us to set up a payment plan. We will work with you to set up a reasonable plan and prevent your account from being turned over.

How do you handle vaccination charges?

If a vaccine is given to your child and your insurance company processes the claim as ‘not a covered benefit’, then you are responsible for the payment in full.

If I have a newborn, what do I do?

If you have a newborn, you must add your new child to your insurance policy as soon as possible otherwise the insurer may permanently deny payment for in-hospital services by day 31.

How are hospital visits covered?

If we see you in the hospital, we may mail you a bill for those services and a reminder to add your child to your policy. Once you have requested that your insurer add your child, please notify us and we can bill those services directly to your insurer.

How is the coverage handle for emergency room visits?

If you need to access emergency room care or your child is hospitalized, please make sure to call both your insurer and our practice to let us know about it. Coverage will often be denied if proper notification is not made.

About Well care versus Sick visits

You may have insurance that does not cover you and your dependents for ‘well care’. However, under no circumstances can we list well visits as sick care. It is fraudulent for us to do so and at no time will we undertake to commit fraud for any reason whatsoever.

About Well and Sick Visits at the same time

We do not want you to be surprised by an unexpected bill so it is important to be aware that claims sent to your insurance carrier must accurately reflect all services provided at each office visit.

If your child is being seen for a physical exam and a new or ongoing problem that may otherwise have been addressed at a separate visitis identified, discussed, and/or treated at that visit, both services are required to be reported and billed to your insurance company.

Examples:

  • ear infections
  • bad coughs
  • significant chronic conditions

Your insurance company may choose to process the claim by adding a co-payment or applying it to your deductible.