Billing and Insurance

Billing and Insurance

It is your responsibility to keep us updated with your correct insurance information. Please bring your current insurance card and pharmacy benefit card to all appointments. 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. Without the pharmacy card we are unable to request prior authorizations for medications.

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 will be financially responsible for your visit if the insurance company will not cover it.

It is your responsibility to know when you are required to pay a copay and what the copay amount is for each type of service.

It is your responsibility to understand your benefit plan with regard to covered services and participating laboratories/facilities. For example: Not all plans cover annual physicals, sports physicals, or hearing and vision screenings. If these are not covered, you will be responsible for payment.

For children younger than 3 years, there may be 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.

The Lifespan lab in our office may not be the preferred lab for your insurance plan. If you are required to use another lab there may be a charge from your insurance if you use this lab. We can provide you with a lab slip to go to another lab if necessary.

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.

As required by 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.

A payment plan may be requested if you are not able to pay your bill in full.  If previous arrangements have not been made with our finance office, any balance outstanding longer than 120 days will be forwarded to a collection agency.

For scheduled non-emergent appointments, prior balances must be paid prior to the visit.

The accompanying parent or adult is responsible for full payment at the time of service. In divorce, please do not place our office in the middle of marital disputes. It is your responsibility to work out the payment of your child’s medical care between the custodial and noncustodial parent.

We accept cash, checks, credit or debit cards (Visa, Mastercard, or Discover). A $25 fee will be charged for any checks returned for insufficient funds. If you have a returned check your account will be placed on cash or credit card only status.

If you file for bankruptcy and have an outstanding balance you will be given 30 days to transfer care to another physician.

Please call the office or our billing department if you have a question about your bill. Most problems can be settled quickly and easily, and your call will prevent any misunderstandings. If you are having trouble paying your bill, please discuss the situation with us. We realize that temporary financial problems may affect timely payment of your account. If such problems arise, we encourage you to contact our office manager promptly for payment arrangements and assistance in the management of your account. Satisfactory arrangements can almost always be made. Financial considerations should never prevent children from receiving the care they need at the time they need it.