Insurance Information and Guidelines
Our entire staff is committed to providing quality medical care to our patients. Our relationship with our patients is important and we want to work with you regarding billing and insurance services. As insurance programs become more and more complex and diversified, it is important that each family understand in detail what their insurance plan covers. It is especially important that you know if your insurance plan covers routine immunizations, well exams, sick exams, or both. No matter what type of insurance you have, you must know what you are financially responsible for, such as co-payments, deductibles, well exams, etc. We expect payment for what you are financially responsible for, such as copayments and deductible amounts, at the time of service. You should call your insurance company and learn what hospitals, ER's, and lab services you can use, since some plans restrict where you can get these services. Unfortunately, we cannot know all the coverage rules and restrictions for each insurance plan, so we rely on the family members to research this thoroughly.
Pre-Certification and Referral Forms
Some plans require that you obtain precertification for referrals to specialists or diagnostic centers for consults or procedures. You should become familiar with this aspect of your insurance plan. If you need a referral form, please allow 5-7 weekdays for processing.
When we recommend a referral to a specialist, we usually advise the following steps:
- The family will call to schedule an appointment with the specialist or for a diagnostic procedure. At this time, the parent must verify with the specialist that they are "in network".
- After an appointment time is confirmed, the parent must call our office and talk to our insurance staff in order to obtain a referral or authorization prior to the appointment with the specialist or diagnostic procedure.
Please note that in cases of emergency -urgent consultations or procedures, these steps will be rushed and health issues become the number one priority, not paperwork. In our opinion, health issues are always priority.
Health Insurance Plan Participation
Insurance/PPO Contracts:
We currently participate in many different health insurance plans. Our level of participation will vary from time to time. Our participation in PPO type plans is very stable and does not change often. It is best to ask our insurance trained staff members if you have questions about our participation in your particular plan.
HMO Contracts:
Our participation in HMO plans is more limited. HMO contracts are restrictive and it is essential that you become familiar with your plan and its rules. All of our physicians and nurse practitioners are available to see patients in all of our participating insurance plans. If you have any questions about HMO plan participation, please contact our business staff.