Practice Policy Summary

We encourage to review our parent agreement document so that you become familiar with our practice’s policy. There are a few items we’d like to highlight regarding our practice's policies especially.

Insurance Plans Benefits and Coverage


We try our best to be familiar with your insurance coverage so that our clinicians can provide you with covered care. However, there are so many different insurance plans that it’s not possible for our pediatricians or staff members to know the specific details of each plan. Every insurance plan may have different rules that vary from insurer to insurer and may even vary between plans of the same insurer.  

Insurance companies determine what tests, drugs, and services they will or not cover based on your policy. Thus, your financial responsibility is defined by the rules of your insurance company.
 

How We Practice Medicine

Our practice firmly believes that providing medical care to children based on the type of insurance you have is contrary to our high-quality standards. Thus, to provide the best pediatric care available to you consistently, we follow the American Academy of Pediatrics recommended quality-of-care guidelines.

Simply put we don't treat patients based on their insurance coverage, but rather treat patients based on our clinical judgment, expertise along with the AAP's unbiased, quality-clinical standards.
 

Insurance Plan and Benefits

We recommend that you check with your particular plan in advance to find out what services are covered and how much they will reimburse you for medical expenses. Take the time to read your insurance policy. It’s better to know what your insurance company will pay for before you receive a service, get tested or fill a prescription.

Some kinds of care may have to be approved by your insurance company before your doctor can provide them.

If you still have questions about your coverage, call your insurance company and ask a representative to explain it.

Remember that your insurance company, not your doctor, makes decisions about what will be paid for and what will not.
 

Credit Card on File

We require all parents to put a credit card on file with our office. Credit Cards on file will be processed for the patient responsibility amount, per your health plan’s Explanation of Benefits, 5-days after the patient’s health insurance carrier processes the claim.
 

Statements

To contribute to a more ecologically friendly environment, we do not mail paper statements to parent's and guarantor's home. Instead, charge details are posted on your child's FREE patient portal account.
 

Billing Process

Once your health plan has processed the claim for your visit, you will receive an automated email (to the email on file we have on file) with information regarding the charge to your credit card. Your health insurance plan determines the patient responsibility amount according to your plan benefits (i.e., deductible, copayment or coinsurance).

As in-network providers, we are contractually obligated only to collect what a patient's health plan determines as patient responsibility. We do not process cards with arbitrary amounts.  

Parents will receive two automated email notifications concerning the charges. The first email is sent 5-days before the card is charged. The second email is sent after the credit card is charged.
 
  1. We will submit your claim to your insurance company as we’ve always done.
  2. Your insurance company will process the claim and send us an EOB (explanation of benefits).
  3. The explanation of benefits details what your insurance covered, what was written off - or discounted - and what is your responsibility. You will also receive the SAME  EOB from your insurance company.
  4. We are not allowed to charge you any amount. We are allowed ONLY to charge you what your insurance company says is your responsibility according to your health plan benefits.
  5. Once we receive the claim from your insurance company and process it accordingly, our automated system will send you an email - 5 business days prior - to notify you that your card is going to be processed.

If you have any questions or issues, you are free to call us within the 5 days. We can put the charge on hold if there is anything that you want to check.

If the amount to be charged is too much for your family budget, give us a call immediately, and we will be happy to set up a payment plan.

No Shows

We don’t charge for no-shows. However, we do take them seriously. And that is because when a patient fails to keep an appointment, we are unable to provide medical services to someone else that needed to be seen.

We consider a no-show, a patient who reserves a place on our schedule, but neither uses nor cancels with at least 24-hour prior notice the appointment

Patients that have two no-shows within a 6-month time frame will be discharged from the practice.
BENEFITS COVERAGE
   

Every insurance plan may have different rules that vary from insurer to insurer and may even vary between plans of the same insurer.  

 

We try our best to be familiar with your insurance coverage so that our clinicians can provide you with covered care.

 

However, there are so many different insurance plans that it’s not possible for our pediatricians or staff members to know the specific details of each plan.

 

 

We recommend that you check with your particular plan in advance to find out what services are covered and how much they will reimburse you for medical expenses. Take the time to read your insurance policy. It’s better to know what your insurance company will pay for before you receive a service, get tested or fill a prescription.

If you still have questions about your coverage, call your insurance company and ask a representative to explain it.

Remember that your insurance company, not your doctor, makes decisions about what will be paid for and what will not.