Thank you for your business. We do expect payment within 30 days, so please process our invoice within that time. We encourage patients to leave a credit card on file as a feature we offer for convenience.
TELEMEDICINE DURING COVID-19
In an effort to decrease the spread of SARS-CoV-2, we, under the support and guidance of the Governor of Rhode Island, will continue to provide telemedicine visits to you and your family. Please note that these visits are billed to your insurance company. Unfortunately, some insurance plans may not follow the Rhode Island Governor’s executive order which mandates coverage of telemedicine visits. Please be sure to check with your insurance company so that you know your benefits.
CO-PAYMENTS AND BALANCES
We require that you pay for the office visit or co-pay upon arrival in our office. We accept cash, check, and credit card. There is a $25.00 fee for returned checks. If you have any billing questions, please contact our billing manager.
MISSED APPOINTMENTS
Please help us to provide professional and timely care to all our patients by keeping your scheduled appointment and arriving on time. If you arrive 15+ minutes late for your scheduled appointment, we may have to reschedule to another day or time and you will be charged a missed appointment fee. If you are unable to keep a scheduled appointment, a 24-hour notice is required to avoid a $50.00 charge. Multiple missed appointments may prevent us from continuing to provide you with care. In an attempt to help you keep your appointments, we have an automated text reminder system that will text appointment reminders straight to your phone! If you are signed up for MyChart you will also receive a MyChart reminder in your email. Three missed/no show appointments may result in dismissal from the practice.
AFTER HOURS CHARGES
There is an extra charge for visits on Saturday, Sunday, and holidays. Some insurances may not cover this extra charge.
BILLING
In order to keep our charges as reasonable as possible, we ask that you pay all co-payments and balances on the day of your child’s appointment. Payment plans can be discussed on an individual case by case basis.
We do expect payment within 30 days, so please process our invoice within that time.
Invoices not paid in full within 120 days will be referred to a collection agency and may result in your child’s dismissal from our practice.
INSURANCE PLANS
Please have your child’s current insurance card available to us at each office visit. We must have the correct insurance information so that we can submit claims to your insurance company for timely and proper payment of services we have rendered. If you do not have a valid insurance which we can verify electronically, you will be considered a “self-pay” patient. This means you will have to pay for the visit in its entirety the day of service. We will give you a receipt as record of payment for you to submit to your insurance company for reimbursement. If your insurance company has not paid a claim after 60 days from the date of the visit, the bill becomes your responsibility. If your coverage was terminated and you do not present us with the new insurance card within 30 days of the date of service, the bill is your responsibility.
East Bay Pediatrics has enrolled in numerous managed-care insurance programs to accommodate our patients. Each plan has different requirements placed on you, the subscriber, to determine if the insurer will pay for your medical expenses. Even within the same insurance company, the plans differ in the type of contract you or your employee has negotiated. Therefore, it is your responsibility to know and understand the specific details of your insurance plan to avoid potentially needless out-of-pocket expenses. While we may assist you with pharmacies, referrals, and laboratories, it is not possible for us to be familiar with the specific coverage of your particular insurance plan. Some insurance plans limit procedures and services in order to control costs. It is our responsibility to provide your child with what we consider to be the best medical care according to current practice guidelines. Certain services we provide may not be reimbursed by your insurance company and will therefore become your financial responsibility. These services may include:
- Lab/imaging studies: Your insurance carrier may require you to use a specific lab or other outside facility. Failure to do so may result in charges to you which your insurance company does not cover.
- Referrals: Most managed care plans require that we receive authorization for referrals to a plan’s list of specialists. If a specialist is not on your ‘list’ or if authorization is not received in advance, you will be required to pay out-of-pocket for the appointment.
- Other services: Fluoride applications, cholesterol testing, hearing tests, extended telephone conversations and written correspondences. If these services are not covered by your insurance carrier, you will be billed for these services directly.
Please make every effort to become familiar with the benefits of your plan. If you have any questions regarding your coverage, please contact your insurance company directly.
If we participate with a company that insures you, we will submit the bill for you. You are, however, responsible for any deductibles and balance your plan indicates on their EOB (explanation of benefits). We send a monthly statement to the individual listed as the ‘subscriber or responsible party’ on the Demographic Form for any outstanding balance and for charges stemming from services not covered by your insurance company. These balances are due in full within 30 days of your first billing.
INSURANCES ACCEPTED:
Aetna
Blue Cross Products
Cigna
Great West
Harvard Pilgrim
Health Care Value Management
Medicaid
PHCS
RITE Care Products
Tufts
Unicare
United Health Care Plans
We may also participate with other smaller plans not listed. If you are not sure whether we accept your insurance, please call the customer service number on the back of your insurance card to obtain this information.
HIGH DEDUCTIBLE INSURANCE PLANS
If you have a high deductible insurance plan, we ask that you provide us with a credit card prior to the office visit. If that is not possible, we ask for a down payment prior to the visit if your deductible has not yet been met, as is often the case early in the calendar year. We have set that down payment to reflect the average charge of a recheck, sick, or well visit to our office. When you check out, you will be informed and asked to pay for any additional expenses incurred during the visit. We will continue to bill your insurance company and will use the down payment to offset any remaining balance. If the deductible has been met or is less than the down payment made, the amount remaining will be applied as a credit toward your account. We adhere to the same policy for families that lack health insurance.
REQUEST FOR RECORDS
There is a $25.00 fee for copying a medical record.
DIVORCE SITUATIONS
The parent who brings the child in for the visit is responsible for payment at the time of service, regardless of the financial arrangements of the divorce agreement.
DELINQUENT ACCOUNTS
Any balance that remains unpaid after 120 days without attempts at resolution will be considered delinquent and submitted to a collection agency. If your family is experiencing a financial hardship, please let us help you set up a mutually acceptable payment plan. If an account is seriously delinquent, we may be unable to provide any further medical care to your children. If your child’s account has a patient balance for over 90 days, East Bay Pediatrics will not make additional appointments for routine care until good faith attempts are made to pay off the remaining balance. The account will also be given to our collection agency if there is an outstanding patient balance on a child’s account of over 120 days.