Welcme t Raleigh Pediatrics Assciates! We re glad yu ve chsen us as yur child s pediatrician and strive t give yur children the best in medical care. We understand that in additin t feeling cmfrtable with yur child s physician, many parents have cncerns abut the financial plicies f the practice. This infrmatin is designed t answer frequently asked questins. CONTRACTED INSURANCE FILING General Infrmatin Raleigh Pediatrics has agreed t file insurance fr patients wh participate with ur cntracted insurance plans. In rder t d this as accurately as pssible, we MUST see yur child s insurance card at each visit r be able t verify yur child s cverage nline. If yu participate with a managed care prgram, ne f ur physicians names must be listed with yur child s name. IF YOU DO NOT HAVE YOUR CHILD S INSURANCE CARD AT EACH VISIT, ANOTHER PHYSICIAN NAME APPEARS ON THE CARD AND/OR WE ARE UNABLE TO VERIFY COVERAGE, YOU MAY BE ASKED TO LEAVE PAYMENT AT THE TIME OF VISIT AND/OR SIGN A WAIVER. Cntinued nn-cmpliance with presenting insurance verificatin at each visit may result in terminatin f care. We will, in sme cases, accept nline eligibility as lng as it includes all verifiable infrmatin pertaining t yur child s cverage. This infrmatin includes patient s name, prf f eligibility n the date f service and verificatin that cverage is with a CONTRACTED insurance plan. Keep in mind that we MAY NOT be available t verify cverage by telephne r internet when yu present fr a visit. It is the parent s respnsibility t have this infrmatin available t whmever is presenting the child fr a visit (spuse, grandparent, nanny, etc.). ALL cpayment amunts are due when services are rendered. In additin, we will ask fr all balances n prir visits that have becme yur respnsibility since filing. As we d Family Billing these amunts may be n any child in yur family (nt necessarily the child being seen that day) and may be due t cpay/cinsurance/deductible/nn-cvered services r patient ineligibility. After we file yur visit and receive a respnse frm yur insurance cmpany, yur balance fr that service date is due IMMEDIATELY. Discrepancies with yur insurance determinatin f bills must be handled between yu and yur insurance cmpany. In rare cases we will cntact yur insurance if yu have been led t believe there was an errr n ur part. Hwever, in rder fr us t take actin with yur insurance cmpany, we need a reference # and the name, phne number and extensin f the insurance rep yu spke t. Page 1 f 5 kfm 4/2014 rev.6/2015,4/2016,3/2018
CONTRACTED PLANS Raleigh Pediatric Assciates participates with the fllwing insurance carriers: AETNA BLUE CROSS/BLUE SHIELD CIGNA HEALTHCARE CIGNA EXCEPTIONS Raleigh Pediatrics des NOT participate with Cigna Indemnity plans r Cigna Cnnect. If yu have ne f thse plans and chse t cme t Raleigh Pediatrics, yur accunt will be cnsidered Self Pay. Yu must pay in full at time f service and file yur wn insurance. N cntractual adjustments will be made t these accunts. COVENTRY HEALTH CARE OF THE CAROLINAs MEDCOST PPO MEDICAID/CAROLINA ACCESS* ONLY ACCEPTING PATIENTS WHO MEET THE FOLLOWING QUALIFICATIONS: New patients 2 mnths f age and yunger Established patients and their siblings NORTH CAROLINA HEALTHCHOICE UNITED HEALTHCARE PRACTICE EXCEPTIONS Raleigh Pediatric Assciates is clsed t the fllwing patient ppulatins: MEDICAID/CAROLINA ACCESS-Currently pen nly t new patients 2 mnths r yunger, established patients r the sibling f an established patient. Please read belw regarding definitin f established patient.* * A patient is cnsidered established nly if they have been seen by ne f ur physicians in the last 3 years and have nt transferred ut f the practice. TRICARE-Unless primary insurance is ne f ur cntracted plans. Page 2 f 5 kfm 4/2014 rev.6/2015,4/2016,3/2018
PARENT/GUARDIAN FINANCIAL RESPONSIBILITIES Payment due at the time services are rendered include: YOUR FAMILY S CURRENT BALANCE This includes any services that are deemed t be family respnsibility (additinal cpays, cinsurance, deductible, etc.) r that are cnsidered nn-cvered by yur insurance. In additin, any services that we file with yur insurance that are nt respnded t any time after 90 days frm the date f service may be transferred t patient balance. This balance will remain the respnsibility f the family until payment is received r written crrespndence is received by the insurance cmpany verifying that payment is frthcming frm them. SELF PAY PATIENTS Payment in full is DUE at the time services are rendered. Raleigh Pediatrics DOES give a discunt t Self Pay patients wh pay IN FULL at the time f visit. NON-CONTRACTED INSURANCE (Als cnsidered SELF PAY PATIENTS): IF Raleigh Pediatrics des nt participate with yur insurance plan, yu MUST pay in full at the time services are rendered. Self Pay discunt will als apply t patients with nn-cntracted insurance as lng as they pay IN FULL at the time f visit. We will prvide yu with a frm suitable fr filing with yur insurance cmpany. Yu need nly t fill ut yur prtin f the insurance claim frm, attach ur encunter frm and mail t yur insurance cmpany. CONTRACTED INSURANCE Any amunts that are pre-determined t be yur child/family cpay/c-insurance/deductible are due when services are rendered. After we file yur visit and receive a respnse frm yur insurance cmpany, yur balance fr that service date is due IMMEDIATELY. SPECIAL CHARGE NOTES: AFTER HOURS - There is an additinal charge fr visits after ur regularly scheduled appintments. These mst likely wuld be requests fr care after 5:00 pm Mnday-Friday, fr Saturday and Sunday visits, and fr visits n ffice hlidays when we have limited staffing (Gd Friday, Memrial Day, 4 th f July, Labr Day, Friday after Thanksgiving). OUTSIDE LAB CHARGES - If lab wrk needs t be sent t an utside labratry, yu will receive a separate billing frm that lab. Make certain yu apprise ur medical staff IF yur insurance requires that lab wrk be sent t a specific vendr. Page 3 f 5 kfm 4/2014 rev.6/2015,4/2016,3/2018
Cntinued --PARENT/GUARDIAN FINANCIAL RESPONSIBILITIES AFTER FILING Any services that are deemed t be family respnsibility (additinal cpays, cinsurance, deductible, etc.) r that are cnsidered nn-cvered by yur insurance will be put t patient balance and are due IMMEDIATELY. Any services that we file with yur insurance that are nt respnded t any time after 90 days frm the date f service may be transferred t patient balance. This balance will remain the respnsibility f the family until payment is received r written crrespndence is received by the insurance cmpany verifying that payment is frthcming frm them. A mnthly statement will be sent t yu detailing unpaid charges. If yu have questins regarding items which have nt been paid by yur insurance, we ask that yu cntact yur insurance cmpany r emplyer as benefit packages vary by emplyer. SEPARATED/DIVORCED FAMILIES A cpy f this plicy in its entirety is available upn request. Fr thse families where parents are separated r divrced, the parent authrizing treatment and bringing the child t be seen is respnsible t us fr payment. All payments are due when services are rendered. In the case f cntracted insurance nly, cpay, c-insurance and/r deductible may be due at the time services are rendered. Subsequently all charges deemed parent respnsibility by the cntracted insurer are due t Raleigh Pediatric Assciates by the parent wh authrized treatment. If the divrce decree requires the ther parent t pay all r part f the treatment csts, it is the authrizing parent s respnsibility t cllect frm the ther parent. Raleigh Pediatric Assciates will nt act as a mediatr in cllecting ur payments. UPON REQUEST, a cpy f the bill with apprpriate insurance cding will be prvided t the authrizing parent at each visit. If the accunt is nt reslved in a timely manner, the authrizing parent s infrmatin will be submitted t ur cllectin agency. Nn-cmpliance with this plicy may result in terminatin f care. Page 4 f 5 kfm 4/2014 rev.6/2015,4/2016,3/2018
TO CONSIDER BEFORE CHOOSING INSURANCE PLAN Raleigh Pediatric Assciates fllws the American Academy f Pediatrics guidelines. Nt all insurance plans cver the AAPs recmmendatins. Raleigh Pediatrics will nt adjust ff any services r their charges based n yur insurance cmpany s recmmendatins. It is the Guarantr s respnsibility t find ut frm their insurance cmpany what will be cvered BEFORE initiating care. Raleigh Pediatrics fllws all AAP guidelines regardless f cverage. Therefre, it is imprtant fr yu t knw ahead f time what yur ut-f-pcket respnsibility may be. Sme things t cnsider when chsing an insurance plan fr yur child: Althugh MOST insurance plans cver well care visits there ARE sme exceptins. Make certain t check with yur insurance r emplyer ahead f time t ask if well care visits cvered in full and what services are cnsidered well care by yur insurance plan. It CAN vary frm plan t plan. Check t see if there is maximum amunt f well child care benefits available t yu. Are there restrictins t vaccine cverage? Des yur insurance require yur lab wrk t be dne at a certain facility? What labratry tests may nt be cvered? What cverage des yur plan have fr labs dne at the physician s ffice? What is yur respnsibility in terms f cpay, cinsurance and deductible? Mre financial respnsibility is nw n the plicy hlder. Des yur plan cver after hurs care? NEW PARENTs Have yu added newbrn t yur plicy? Mst insurances nly allw 30 days after yur child s date f birth fr yu t add him/her t yur plicy. IF yur insurance requires an assigned prvider r primary care physician t be named, it MUST be a RPA physician. If this is nt dne prperly, the respnsibility f payment may becme yurs. QUESTIONS OR ADDITIONAL INFORMATION?? Please cntact ur AR Department at 919-872-0250/ ext 590. Page 5 f 5 kfm 4/2014 rev.6/2015,4/2016,3/2018