Policy - Financial

As we enter this doctor-patient (parent) relationship, we agree to provide quality pediatric service at a fair and reasonable price, and you in turn, agree it is your obligation to be prepared to pay at the time of service and to understand the benefits of your insurance for physician office visits and any hospitalization, if necessary. We want to explain our Financial Policy to you so there are no unpleasant surprises.

At the end of each office visit, you will receive an encounter form which will detail the type of visit, the procedures or immunizations performed, the diagnosis and the fee for the visit. To help keep your health care costs down, payment is expected at the time of service. Please be prepared to pay the visit fee, any co-payments and non-covered services at the time of each visit. Please bring your insurance card with you for every visit.

Our billing office is available during regular office hours to discuss our charges, insurance questions, the status of your account or to help you with any billing or insurance questions. You may call the Billing Office directly at (717) 755-6260 on the office line. Thank you for understanding our financial policy and please keep our records current with any changes in address, phone number, guarantor or, insurance information.

The practice of medicine has changed drastically since the 1990s. Managed Care (HMO) plans play an increasing role in determining the panel of physicians, the hospitals, the lab and/or x-ray facilities from which patients may receive care. Often there are insurance limitations on what your carrier will pay and what you are responsible for and, we know that insurance and health plans can be very complicated and hard to understand.

To help you, we will submit claims to all insurers and health plans, whether or not we are a participating provider with that insurer or health plan. We will do this in a timely manner as a courtesy to you.

Since our patients are insured by hundreds of different insurance companies, we will need your help as well. When it comes to filing claims so your visit is covered or properly reimbursed, we need to get the right information from you.

We have found that 25-50% of our patients make a change that affects their health insurance and reimbursement. If you do not report that change to us, the correct information is not sent to your insurance and health plan. Then you and our billing staff will find your visit not being covered and will spend a lot of time finding the problem, resubmitting your claim, and waiting for reimbursement. To prevent this from happening, our staff will frequently ask you to update your insurance information to have it on file. We must have correct policy, group identification and/or claim numbers, etc. along with a correct billing address. Please let us know, as soon as possible, if you have any change in insurance, employment, address or phone number.

Insurance

Your insurance policy is a contract between you and your insurance carrier or HMO. Pediatric Health Associates, P.C. is not a party to that contract. We must emphasize that as your child's healthcare provider, our relationship is with you, not your insurance company.

Please understand the benefits your insurance or health plan provides for physician office visits. It is your responsibility to know what services are covered. If you are unsure, check with your employer or call your insurer.
Present your insurance or health plan card at each visit. This will allow us to maintain accurate billing information. If your child is seen as a consult, please bring your health insurance card, claim forms, and HMO authorized referral (if applicable) with you.
Please register your newborn infant on your insurance plan as soon as you are discharged from the hospital. Generally, in-office care for your newborn is not covered by insurance until the infant is officially registered on your plan. This should be done before your infant is 30 days old.
Please familiarize yourself with your child's specific insurance plan and your out-of-pocket expenses, such as co-payments, co-insurance, deductible and any noncovered services. Most insurance and HMOs require that a co-payment be made at every office visit, with few exceptions for some plans.
Not all services are a covered benefit in all contracts (often well-exams and immunizations are not). It is your responsibility to be aware of your insurance company's provision for payment of office visits, immunizations, well-child exams, and routine annual exams including school, camp, or sports physicals.
Please remember that you are responsible to pay any charges NOT covered by your insurance such as deductibles, co-payments, and noncovered services at the time of your office visit. Full payment of non-covered services is expected at the time of service.

Insurance Participation

Pediatric Health Associates has participating agreements with the following insurances:

Aetna HMO & PPO
AmeriHealth Administrators
Capital Blue Cross
Carefirst BC/BS of Maryland
Champus/Tricare
Cigna Healthcare HMO & PPO
Devon Health Services
Educators Health Partners
Gateway Health Plan
First Health
United Healthcare

Great-West Healthcare
Geisinger Health Plan
Health America
Health Assurance
Highmark Blue Shield
Keystone Health Plan Central
Medicare
Pennsylvania Medicaid
South Central Preferred
Private Health Care Systems(PHCS)
Unison Health Plan

Payment Procedures

To help keep your medical costs down, payment is due at the time of service. For the convenience of our patients, we accept cash, checks and Visa/Mastercard. If you cannot pay at the visit, you will be given an envelope to send your payment to us within the next 30 days.
Payment at the time of visit will help us maintain office fees as low as possible, a savings to you. Due to the high cost of billing, we would prefer not to have to send out monthly statements.
There will be a $5.00 billing charge added for each monthly statement issued after 30 days, and this includes those who fail to pay their co-payment while in the office.
It is our office policy to bill insurance plans in which you participate as a courtesy to you. Nevertheless, YOU are responsible for payment regardless of any insurance company's decision to deny coverage or to reimburse less than our charge.
If you are a member of a non-participating plan, we will be happy to file your claim for you. However, you are responsible for paying for services at the time of your visit. Once your claim is processed, any reimbursement due should be sent directly to you by your insurance carrier.
If your insurer should pay us directly, we will reimburse you for your share in a timely manner, or if you wish, we can apply this payment as a credit on your account.
If both parents have health insurance, the parent with the first birthday of the year is most often the primary insurer. Please check your insurance policy to determine which is primary before your appointment.
If your teen's or young adult's visit is a result of an auto accident or worker's compensation claim, please be prepared to bring to the office all the required information for that visit, including a copy of your auto insurance card.
Since most patients we see are minors (under age 18 years), we consider the parent/guardian accompanying the child as the responsible party, unless other arrangements have previously been made.
Any patient who is a young adult (over age 18 years) is legally an adult and responsible for his/her medical care costs. We will honor the parent's insurance if the patient is still covered (usually college students).
If you are having a financial problem paying for medical services, we are willing to work with you. Please call the Billing Office to arrange an extended payment plan to help you meet your obligations. When you agree to an extended payment plan, we expect you to pay your monthly payments as agreed upon.

Collection Policy

Any accounts over 90 days with no payment activity or any attempt to pay or contact the Billing Office may be turned over to our collection agency. Please don't just ignore these statements; please contact us to help you meet your obligations.
If your account is currently in collection status, all future services will be on a CASH BASIS only and will be limited to sick visits only. If your account with collection is not paid by 6 months, you will be discharged from the practice.
Any patient who has transferred out or was discharged from the practice due to a billing problem will be required to pay the previous balance prior to being seen again.
If you have a previous outstanding balance for hospitalization or other bills and now get new insurance to cover your current charges, you are still responsible for the PREVIOUS OUTSTANDING BALANCE and may be subject to collection, if not paid, despite any new insurance.

Additional Charges and Assessing Fees

There will be a $30.00 fee assess for all return checks, marked “Insufficient Funds” or “Stay Payment” issues by your bank.
There is a $5.00 billing fee assess for each and all monthly statements sent out beyond 30 days, which includes those who fail to pay their co-payments.
Our policy is to charge a minimum of $25.00 up to the charge for an office visit for missed appointments, unless canceled 24 hours in advance. Please note: Should you miss more than three appointments and fail to cancel the appointment in advance, you will be charged an office visit fee of $25.00 and will be discharged from the practice.
There will be a charge for copying medical records depending on the quanity of pages and a medical record release needs filled our prior
After-hour and weekend visits when the office is closed, will be an additional $30.00 FEE. On SATURDAY’s there is an after hour charge of $32.00 FEE, and if the child is seen on an EMERGENCY BASIS it is a $65.00 FEE.

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