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Insurance & Billing

 

What You Should Know....Common Financial Misperceptions

"Can you also take a look at …?" Combining a sick visit with preventive visit.

There is a misperception that one can get as many things seen as possible during a physical or well child visit. The best way to understand how this works is to compare the well child visit to a tune up on your car. We do not like the analogy, but there are similarities. Getting a tune up on your car is similar to a preventive visit/well child visit. If your mechanic finds a problem, he or she will fix it for a charge above and beyond the tune up charge.  Your insurance covers screening and assessments of your child's development at a well child visit. Addressing issues and concerns are not covered as part of the preventive visit (i.e. reflux, cough, fever, ear infections, etc.).  These non-preventative issues are handled the same as a problem found with the car.  We are legally required to report to your insurance all services provided during the visit.  Your insurance may determine that a copay is warranted and will be billed as such.

"Is this covered?" Discussing benefits.

It is impossible for your provider to know the details of your insurance plan. Each employer that offers health insurance to its employees has a unique contract with the health insurance company. Thus, there are thousands of subtle differences even within the same insurance carrier. Even your insurance will not guarantee coverage prior to the claim being processed. If you have questions regarding your insurance plan, please contact your insurance to check your benefits.  Your insurance will make the final coverage determination when they process your claim.

Additional Services.

If you come in with a long list of items to address, it is highly likely that the provider will not be able to address all of the items in the allotted time or there may be additional charges. For example, if you schedule an appointment for a sore throat but in the exam room ask that the provider remove a wart, the wart removal is considered an additional service.

Unscheduled Siblings of Scheduled Patients.

Because of the busy schedule, the provider may or may not have time to see a child who is not scheduled to be seen. If the provider does have time, the additional visit will be billed separately. Depending on your insurance, this may also require an additional co-pay.

 

Direct your children onto the right path, and when they are older, they will not leave it. Proverbs 22:6