Insurance Policies

If you are insured, The Pediatric Center will try in every way we can to make the processing of insurance claims as simple as possible.  In order to do this we ask that you please come to your child’s appointment with your current insurance card to ensure we have the most correct information for claim submission.  We also ask that you are prepared to pay any patient portion that you may owe or that is required of you to pay. 

If your children are not insured payment is expected at the time of service. Insurance companies do not always pay for all medical services, even those that might be helpful to the patient.  It is very important for you to know and understand your insurance benefits.  There are many policies and plans for each person or employer group, and we are unable to determine what your policy benefits are for each visit based on the information on your insurance card. 
We encourage you to ask your insurance plan important questions regarding your benefits such as:

  • Do I have well child or preventative care for my child?
  • Is there a limit or maximum benefit to the well child or preventative care?
  • Are the vaccines covered by my insurance
  • Are there vaccine coverage limitations? The Pediatric Center follows the current immunization guidelines established by the American Academy of Pediatrics (AAP).
  • If my child is having an office procedure done, such as wart removal, mole removal, fracture care, laceration repair etc. what will I be responsible to pay?
  • Does my plan have a deductible that will need to be paid each year and how much is my deductible?
  • How much is my copayment?
  • Coinsurance is a percentage of the charges that may be your responsibility and is not part of the copayment.
  • Is the physician or physician assistant participating with your insurance plan?

Federal laws require The Pediatric Center to submit every claim to an insurance company accurately, reporting the exact services performed and the exact reason for performing them. Sometimes insurance companies may not pay all charges as they were submitted by The PediatricCenter.  We cannot change a diagnosis code or a procedure code after the original claim submission (unless it was initially submitted incorrectly) so the claim or some of the services can be paid by the insurance company.

Sometimes during a preventive health visit the physician will diagnose and treat another problem. Services for the other problem will be billed as an additional charge. Some insurance companies will not cover two office services on the same date so payment for one of the services may be denied by the insurance company or an additional co-payment may be required.

After we receive a response from your insurance, you will receive a statement indicating any amount that you may owe.  Payment is expected at the time of service, however we realize due to benefit coverage you may not know the exact amount to pay.  We ask that you pay immediately upon receipt of your first statement any and all balances which are due from you