Insurance & Payment Policies

For well visits, make sure that your insurance company will cover the exam if it has been less than a year since the last one. Some insurance companies require a full calendar year between well visits (starting at age 2 years) while others allow a physical anytime within each year (one in 2017, one in 2018, one in 2019, etc.) ​Here is a current list of insurance companies of which we participate. Please note: that this list is subject to change. If you have any questions regarding insurance, please call our office. Aetna Blue Point Blue PPO Cigna EBS Benefit Solutions Emblem Health Empire Blue Cross/Blue Shield Excellus Blue Cross/Blue Shield Fidelis First Option Health GHI Great West PPO HealthNow of New York Healthsource Provident (through Cigna) Healthsource Provident (through PHCS) HMO Blue MultiPlan MVP North American Preferred – PPO, Care Net And Preferred OnPoint Private Healthcare Systems POMCO Preferred Care RMSCO United Healthcare – Empire, HMO, POS, PPO, EPO, Choice Plus Univera Healthcare

We accept cash, check, post-dated checks, and Visa or Mastercard.

We need your insurance information to be able to bill your insurance company. This requires that you give us a copy of your insurance card. Please note that your insurance policy is a contract between you and your insurance company. We are not a party to that contract so you are responsible for understanding your insurance benefits and resolving conflicts or disagreements with your carrier.

Co-payments are due at time of service, as per your agreement with your insurance company. Because it costs us more to bill a co-payment than the co-payment itself, Pediatric Associates charges a $10.00 service charge if you are unable to pay your co-payment at the time of service.

Full payment is expected at time of service. All accounts with unpaid balances over 60 days will be assessed a $15.00 monthly statement fee.

If we have been unable to resolve your insurance claim within five months, we will notify you by U.S. mail requesting you check into the delay. If the claim is still unresolved after six months, we will request payment directly from you.

Pediatric Associates cannot always tell you in advance whether or not your charges will be covered by your insurance plan. Each insurance company has multiple plans that vary with employer group contracts. We ask that you be as familiar as possible with your own insurance plan, including types of coverage and restrictions on use imaging (such as x-rays), laboratories, and emergency rooms.

Our practice is committed to providing the best treatment for our patients and we charge what is usual and customary for our geographic area. You are responsible for payment regardless of any insurance company’s arbitrary determination of usual and customary rates.

The adult accompanying a minor and the parents (or legal guardians of the minor) are responsible for full payment at time of service.

As a courtesy to our office and other patients, we request at least 24 hours’ notice for appointment changes. If an appointment is missed, a no show fee may be charged.