We know that there are many questions when it comes to dealing with insurance companies and medical bills.

Please bring your most current insurance card at the time of service as this information needs to be updated to provide you with the most efficient billing service.  Your insurance card will indicate your co-pay, if any. We are required to collect all co-pays at the time of service and, by law, are unable to write off a co-pay.

There may also be times when a child needs a service that is not considered preventative on the same day as a well-child visit. If a child is not well or a problem is found or needs to be addressed during the checkup, the physician may need to provide an additional office visit service (called a sick visit) to care for the child. This is a different service and is billed to your health plan in addition to the preventative services provided that day. If you have a co-payment for office visits or coinsurance or deductible amounts that you must pay before your health plan pays for these services, our office will charge you these amounts.

We value your time and want to make the most of each appointment for your child. This is why we will try to/when able address any problem that needs a doctor’s care during well-child visits so that only one trip is needed. Some services that may be provided and billed in addition to preventative services include:

  1. the doctor’s work to address more than a minor problem, which will be billed as an office visit (eg, if the doctor gives a prescription, orders tests, or changes care for a known problem)
  2. medical treatments (eg, breathing treatments)
  3. any surgery (eg, removing splinters, or something the child put in his/her nose or ear)
  4. tests performed in the office that are not included in the Bright Futures plan

Our office does not want you to be surprised by a bill but must always bill your health plan based on the actual services provided. Please feel free to ask questions about services that may not be paid in full by your health plan on the day of your visit. It is our pleasure to help.

Below we have listed the answers to the most commonly asked questions. We hope that this will be helpful. If you need further assistance, please feel free to contact our business office during regular office hours.

Billing and Insurance Frequently Asked Questions:

Q: Why do I get a separate bill for each child?

A: You shouldn’t. Each child has their own individual account number but should all be listed on one statement. If you do receive more than one, please let our business office know and we will correct the problem.

Q: I received a statement from you showing that my insurance company has not been billed. Why is that?

A: Most often it is because we did not receive your current insurance information while you were in the office. If you did give us a copy of your card and you’re still receiving a bill, it may be because we failed to link your new information to the visit properly. Either way, if you let us know, we can easily correct the problem.

Q: I received a statement with the note that I should contact my insurance company. Isn’t that your responsibility?

A: Often insurance companies will request information from their members before they will pay a claim. They require that the insured be the one to provide this information and will not accept it from our office. Most often, they have a question about possible other insurance coverage or they want information about an injury to see if any other party is responsible before they pay. Usually, a quick phone call to your insurance will clear up these questions and they will proceed with claim payment.

Q: My child was seen for her annual well child visit and my insurance company denied payment as ‘maximum benefits have been expended for this service’.  I thought preventative care was covered under my policy?

A: Many insurance policies have maximum dollar amounts that they will pay per calendar year for preventative care.  If your baby is coming in every couple of months during the first two years of life, you may very well max out your benefits.  Some insurance policies will only cover up to a certain age or will only pay every other year after a certain age.  A few plans will not pay at all over the age of 6.  Please make sure that you are familiar with your benefits as there is much variation between policies.

Q: I thought my well child visits were covered in full by my insurance, why am I receiving a bill for a portion of the charges?

A: There are two common scenarios that cause the physical to not be covered in full. The first is that many insurance companies do not cover the routine hearing screening (or audiometry) portion of the exam. The second is when the child has a symptom or illness that is not routine and that is treated at the time of the well child visit. For example if your child has a rash or an ear infection that is treated by the doctor, it may result in an additional office fee, and you may receive a bill for the copay or deductible if that applies on your policy.

Q: What if my child is in a motor vehicle accident, how will those services be billed?

A: The general rule is that your medical insurance will not be billed as they will not cover any charges that result from an MVA. Some exceptions do apply. We recommend you call your medical insurance and inquire if they will cover these charges. Most often, your automobile insurance is responsible for these charges. We are not contracted with auto insurance and are unable to bill them directly. We can provide you with an itemized statement which you can submit for payment. Please be aware that you are ultimately responsible for these charges.

Q: Both parents carry insurance for their child, which policy is the primary?

A: All insurance companies follow the birthday rule. The parent whose birthday falls first in the year will be considered the primary insured. We are happy to bill both your primary and secondary insurance carriers provided they are contracted with us to do so. But ultimately, you are financially responsible for any outstanding balances after insurance payments.

Q: How do I know for sure if your doctors are covered under my insurance plan?

A: The best way to know for sure is to call your insurance and ask them directly. We are contracted with many insurance companies so there should be no problem. However, there are times we may choose not to renew our contracts with an insurance company and the information listed on the physician booklet may be obsolete and inaccurate.