Billing FAQ
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How often will I receive a statement?
Approximately every 28 days, but at least once a month. Why does the statement show a total account balance when I have insurance coverage? You need to be aware of the total charges so when you receive your explanation of benefits (EOB) from your insurance company you can compare it to your statement. What does “adjustment” mean? The insurance adjustment is the difference between what we charge and the contracted rate we have with that particular insurance company. When we sign a contract with an insurance company, we agree to accept the amount the insurance company sets as the allowable amount. You may have a co-pay, co-insurance and/or a deductible included in the allowable amount, so it does not necessarily mean you have no financial responsibility. Are co-pays due at the appointment date? Yes. Per our contract with your insurance company, all co-payments are due the same day services are rendered. The office will charge a $5.00 late fee for any co-pay not collected at time of service. What if I cannot pay the amount I owe in full? The billing department will always try and work with you. The first step is communication. Please call our billing department as soon as you realize you can’t pay the balance in full. If regular monthly payments (agreed on by the billing department) are not made, your account may be turned over to a collection agency. Remember, this is a private practice and payment is expected the same day service is rendered. However, if on occasion financial difficulties arise, contact our billing department immediately May I pay my bill with a credit card or a check? Yes. We accept most major credit cards. Checks are also accepted. However, if your check is returned for non-sufficient funds, there will be a $25.00 NSF check return fee added to your account and we will no longer be able to accept personal checks from you. How can I pay my bill? We have four easy ways to pay:
What if there is a mistake on my statement? Please contact the billing department as soon as you realize a mistake has been made. We make every attempt to process your bills correctly, but occasionally there are errors made by us or by your insurance company. We will be happy to review any issues you feel are in error and make immediate resolution. If it is apparent there was no error, we will happily explain why you have a balance due. We find that many people misunderstand their insurance benefits, so we always recommend that you call your insurance company first then call our billing department after you talk to your insurance company. What would happen if I lose insurance? If you have lost your insurance, please contact our billing department as soon as possible. The billing department will be able to advise you of options you may be able to utilize, such as VFC (Vaccines for Family and Children), or Sunshine Health. |
Can we make an appointment if we have a past due balance?
Yes. However, if you have a balance due and have not had any communication with our billing department, you will have to speak to someone in billing before an appointment can be made. It will be at the discretion of the billing department to decide if an appointment can be made. This is a private practice, not an urgent or emergency care facility. If you have an urgent or emergency situation, you will be advised to go to the ER or an urgent care facility if we are unable to schedule an appointment due to financial circumstances. How and why do you bill for after-hours nurse phone calls? If you call our office after hours, on weekends, or holidays, we contracted a group of Registered Pediatric nurses with fifteen years of experience, called “Tele Care” to answer those calls and give you medical advice. This service does not have a billing department so we collect the payment at our office and make the payment to them. We make no profit from this charge. Most insurance companies do not pay for this service. Payment is due for this charge at the next appointment after the call is made; if no appointments occur it will show on your next statement. If an email is on file we will email an online payment option on the next business day after the call. Does my insurance plan cover every charge made at a doctor’s office? No. Insurance does not cover every charge a doctor may deem necessary. If we know an insurance company does not cover a charge, you will be given an Advanced Beneficiary Notice (ABN) to notify you of this and you agree to continue with the non-covered service. You also agree to pay for the services at the time they are rendered. We will do our best to notify you in advance if we know for sure it is a non-covered charge. However, insurance plans change every year and we accept about fifty different plans. We can’t possibly know all the covered and non-covered items of every insurance company, so it is ultimately your responsibility to know what is and is not covered. How long do I have to add my newborn child to my insurance policy? Your insurance company will allow you up to thirty days (not one day more!) to add your newborn to your policy. However, if we do not have the correct insurance information in our office by the time your newborn is two weeks old, you will be expected to pay for any visits at the time services are rendered. You will also receive a statement for any past visits and payment will be expected upon receipt of the statement. If you acquire insurance by the 30th day, we will be happy to submit your claims. If your insurance company pays, you will receive a refund after insurance payment is received. Do you accept any Medicaid Plans? We accept Medicaid for thirty days for existing patients. At the end of thirty days, you will be required to choose our primary care physician and switch to Sunshine Health, United Health Care Florida Healthy Kids, or Blue Cross Blue Shield Florida Healthy Kids. Our panels are closed for new patients with Medicaid and Sunshine. Do you verify insurance coverage before each visit? Every effort is made to verify benefits for each visit. There may be exceptions, such as not being able to contact your insurance company, emergency situations where there is no time to wait, etc. However, it is the subscriber’s responsibility to know the patient’s benefits, and if the insurance company does not pay a claim, you will be responsible regardless of whether benefits were verified. |
