Billing
When visiting our office, please bring your most current insurance
card to ensure the information (group number, provider number, etc.)
is valid at the time of service. Incorrect or out-of-date information
will delay your claim and you may be held responsible for full
payment of the claim. Your insurance card is similar to a driver's
license or credit card - the information must be valid in order for
it to be used.
The insurance companies do not supply us with claim forms or policy
numbers. If your insurance company requires specific forms, it is your
responsibility to provide our office with the same. We must emphasize
that we cannot accept responsibility for collecting or negotiating
insurance claims. We will gladly assist in completion of required
additional forms and supplying additional information and/or
patient records.
Payment
Our extensive experience with treating children has taught us
that your check-out process is made easier by requiring the co-payment
at the time of registration. After visiting the pediatrician your
child may be anxious to return home or restless after receiving an
immunization. By collecting the co-payment at the time of registration,
you are able to immediately leave the office after your appointment.
This saves you time and makes your child's visit more comfortable.
Payment may be made with cash, check, MasterCard, and Visa. Your
co-payment is determined from your insurance card, which you must
bring with you to each visit.
Billing and Insurance Information
We know that there are many questions when it comes to dealing with
insurance companies regarding referrals and bills from physicians'
offices. Below we have listed answers to the most common questions asked
by our parents. We hope that this will help. If you need further
assistance or your question has not been addressed here, please contact
us at 502-339-0444 during regular office hours.
Billing and Insurance Frequently Asked Questions
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Q: I received a statement for services that should have been covered in
full by my insurance company. Why is that? |
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A: If you receive a statement from us and there is a balance that should
have been covered by your insurance company we ask that you call your
insurance company to find out why the claim was not processed correctly.
Please remember that you are going to get an EOB (Explanation of Benefits)
from your insurance company showing how a claim was processed. Please
review these each time, as the insurance company will give an explanation
for charges that they consider patient responsibility. |
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Q: I received a statement from you showing that my insurance company has
not been billed. Why is that? |
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A: There are a couple of reasons why you would receive a statement from
us showing that you are responsible for charges for a visit. Usually it
is because we have not yet received your insurance information, or because
we have billed your insurance several times with no response. We will
typically put a note on your statement letting you know what we need in
order to file the claim through the insurance. There are times that we
just need the parents' help with getting the insurance company to process
the claim. |
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Q: I brought my child in for a well-child visit and payment was denied by
my insurance company as "Maximum benefits have been expended for this
service." Why was that? |
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A: Insurance companies differ in how many well-child exams will be covered
in the first year of your baby’s life. It is best to look at your benefit
booklet or call your insurance company. Please keep in mind that insurance
companies will only cover one exam per year after the child’s first
birthday. When you call to schedule the exam, please ask the receptionist
when the last visit was. We have seen insurance companies deny the claim
if the visit occurred one day shy of a year. |
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Q: If both parents have insurance coverage for their child, which one would
be primary? |
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A: All insurance companies follow the birthday rule. The parent whose
birthday is first in the calendar year will be considered "primary" for
insurance purposes. |
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Q: Will you bill both of my insurance companies? |
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A: At this time we are only billing the primary insurance. If you are
planning to submit a claim to a secondary or supplemental insurance,
please ask your physician for a copy of your bill at the time of your
visit. Once your primary insurance company has sent you the
EOB (Explanation of Benefits) you will want to attach it to the copy
of our bill and send it to your secondary insurance. |
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Q: When and why do I need a referral to see another physician? |
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A: If your child is covered under a managed care plan then anytime you
seek medical care from another physician you will need to get a referral
from your PCP (“primary-care physician”). If you need to have a referral
please contact us at 502-339-0444 and we will assist you with it. Please
keep in mind that we need to have at least 5-7 days notice to get the
referral processed through your insurance company. |
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Q: How do I know if your physicians are covered under my insurance plan? |
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A: We always recommend that you contact your insurance company to see if
we are contracted provider. We are contracted with a large number of
insurance companies, so there should not be a problem. However, there
are times that we may not renew a contract so relying on the physician
booklet may not be a good idea, as these books are only published once
a year and may not be accurate. |
Referral Frequently Asked Questions
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Q: Will insurance companies do retroactive referrals if I see a specialist
and forget to request a referral beforehand? |
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A: Most insurance plans will not honor retroactive referrals.
It is always a good idea to call our office to be sure
the referral is in place before the appointment with the specialist. |
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Q: What if my physician recommends a specialist that is not in my
insurance network? |
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A: A few insurance plans have out of network benefits which will allow you
to see a specialist even if that physician is not contracted with the
plan; however the claims will be paid at a lower benefit rate than if
you stayed within network. In most cases your physician would try to
re-direct your child to a specialist who is contracted, since most plans
do not pay at all if you go out of network. |
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Q: What if my physician recommends speech, physical or occupational
therapy services for my child? |
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A: You should first check with your insurance company to see what therapy
services are covered by your plan. Some plans do not provide these services.
If the benefits are included on your plan your physician will send a
prescription to the therapist that will be used when the therapist bills the
insurance. As with referrals to specialists, most plans will require that
you stay within network. |
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Q: What if my physician recommends a mental or behavioral health referral
for my child? |
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A: Many companies have arranged for other organizations to manage their
mental health benefits. You should look on your insurance card for a phone
number or call the insurance company for information. Usually you will be
advised to call the behavioral health service directly to initiate the
referral instead of contacting our office for a referral. |
Forms
Below is a list of some of the most commonly used forms in our
office. Feel free to print these forms and fill them out at home,
and then bring them with you when you visit our office.
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