Insurance & Billing
Please take the time to be sure you understand your financial responsibilities.
Accepted Health Insurance Plans
We participate in the following insurance plans. If you have questions about whether we participate with your insurance plan, please call your insurance company directly.
Accepted Insurance Plans
- Aetna
- Capital BCBS
- Cigna
- Geisinger
- Medicaid/Geisinger Family PlanNewborns and Complex Medical/Special Needs children only.
- Highmark
- Humana
- Tricare
- UPMC
Our Billing Policies & Your Responsibilities
Thank you for choosing Ideal Pediatric and Adolescent Care, P.C. for your child’s medical care. We are providing you the following information to help you understand our insurance and billing policies. We are committed to the care of your children, and the practice expects that families are committed to paying for the exceptional care we provide.
Every time you visit our office there will be a charge for the appointment. This includes well visits, sick visits and recheck appointments. In addition, our office charges for telehealth appointments, portal messages, and telephone calls, including those after hours.
Insurance companies do not cover all cost associated with the these office visits, and receiving bills from our office will be inevitable. If you receive a bill it means the claim was processed by the insurance company and the remaining portion is your responsibility. These bills need to be paid in a timely manner.
Billing Questions
Questions about your bill? Please contact Amber, our billing specialist at PedsOne, at (866) 371-6118 or info@pedsone.com.
Insurance Benefits
You must know your insurance benefits. Your insurance policy is a contract between you and your insurance company even if your employer provides the policy. You are responsible to know the coverage and know how much of the cost is your responsibility. You will be responsible for any part of the visit cost that your insurance does not cover including deductibles and co-payments.
Insurance Card
You must show your current insurance card at every visit. We will attempt to validate your insurance benefits at the time of service and alert you to any problems. If we cannot validate your insurance and you did not bring your card we will assign you to self-pay status and payment will be due at the end of the visit.
Co-Payments
You must pay your co-payment at the time of the office visit. Our contracts with insurance companies require us to collect your co-payment at the time of service.
Methods of Payment
We accept cash, credit cards (MasterCard, Visa, American Express and Discover), and checks as forms of payment.
Returned Checks
In the event a personal check is returned unpaid from your bank, your account will be charged a $25 fee.
Credit Card on File
You must provide a credit card to be kept on file. Most insurance companies are subject to routine deductibles and co-insurance, thus we require a credit card on file so we can collect those charges as soon as insurance company assigns the appropriate amount of the patient responsibility. Your credit card will only be charged after the insurance company determines your patient responsibility as spelled out in your Explanation of Benefits. Our office will run a report on the 15th of every month and you will receive notification on the day prior to being charged.
Primary Care Provider
You must contact your insurance company and select our office as your primary care provider as soon as your medical records are transferred. If our office and providers are not listed on your insurance card, we cannot bill for the visit and the account will be assigned to Self Pay. The visit charge then becomes your responsibility and will be collected on the day of service.
Laboratory/X-Ray Facility
You must be aware of which lab/X-ray facility your insurance company requires you to use in the event that labs or radiology tests are needed. It is your responsibility to notify us regarding your lab or X-Ray facility preference. If you do not go to the proper lab or X-ray facility, you may receive a bill from that lab or X-ray facility. This is beyond our control, so to avoid cost know this information before your visit.
Newborn and Adopted Children
You must notify your insurance company of your newborn or newly adopted child. Your child will be covered for 30 days under the mother’s insurance policy. The first appointment is covered, but you must call your insurance company to have your child added to the policy. You must have your child added by the 1 month appointment, so call the insurance company immediately and prior to the 1 month appointment to be certain you have the new insurance card. If not, you will be responsible to pay the bill at the time of the visit. If your newborn is not added by the 1 month appointment the visit will be self pay and payment required at the time of the visit.
Phone Calls, Portal Messages, and Telehealth Visits
You must know your insurance company’s policy regarding phone calls, portal messages, and telehealth visits. Our office will bill the insurance company for phone calls and portal messages placed to the office during regular business hours. This applies to phone calls and portal messages when medical advice is given by our nursing staff or the providers. If your insurance company does not cover this service a maximum charge of $15 will become patient responsibility. Telehealth visits with the provider not covered will be billed and become patient responsibility with a maximum charge of $75.
After-Hours Phone Calls
After-hours phone calls to the on call nurse are not covered by insurance and are costly to the practice. We can no longer incur this expense as a courtesy. Given the rising cost, a charge of $15 will be added to the account for all after-hours calls to the nurse.
Canceled/Missed Appointments
You must cancel an appointment for an office visit at least 24 hours prior to the appointment. If you do not cancel or miss the appointment a $50 missed appointment fee will be added to your account.
Daycare, Sports, School and Camp Forms
You must provide or request forms at the time of your visit. We are happy to complete forms at the time of the visit for free and keep universal forms on file. If you do not bring or request a form at the time of the appointment, there will be a $25 form fee applied to the account.
Self-Pay & Non-Participating Insurance
If your account is self-pay, all services must be paid at the time of your visit. This may include situations where we cannot validate your insurance coverage with your insurance carrier. In such cases, we will collect payment at the time of service and refund any amount that is collected once you provide proof of insurance.
If you are insured by a non-participating insurance carrier, we will expect payment from you at the time of service and it is your responsibility to submit any claims to your insurance company for direct reimbursement.
Collection Policy
All statements are due upon receipt. If charges remain unpaid after 30 days, a second statement will be sent with a notice requesting immediate payment. If the statement remains unpaid after 60 days you will be notified and your credit card on file will be charged. If a credit card is not available and the account remains unpaid after 60 days, we may need to send a letter informing you that our relationship is subject to cancellation after 30 days of urgent or emergent care.
We reserve the right to place your account with our collection agency after all internal efforts to obtain payment have been exhausted.
We understand special circumstances can prevent timely payment and our billing specialist will work with families in need to arrange a payment plan if necessary.
Secure & Convenient Online Payments
We work with industry-leader Payment Pros to enable our patients to safely and securely pay their bill online.
