Health Insurance Guide

Patients Are Responsible for Knowing How Their Insurance Coverage Will Impact Their Bill

• It’s very important that each patient contact their insurance company to become familiar with their insurance coverage.
• There are numerous different insurance plans, which make it impossible for us to know each patient’s unique coverage specifications.

Your Health Insurance May Provide Different Benefits During Priority Pediatrics Urgent Care Hours

• Priority Pediatrics urgent care hours are on weekdays from 5:00 pm – 9:00 pm as well as on weekends. For some patients, urgent care benefits are different than the benefits they have for regular care.
• We encourage all patients to contact their insurance to understand their benefits and the difference (if any) in urgent care coverage.

Labs & X-ray

• There may be times when the doctor orders laboratory tests that we do not perform in our laboratory. In those cases, the specimen will be sent to the M Health Laboratory and you will receive a separate bill from them.
• X-rays taken in our office are sent to Children’s Hospital Radiology to be read by a Radiologist. You will receive a separate bill from Children’s Hospital Radiology for these services.

Addressing Non-preventative Care Concerns During a Well Child Visit

• Sometimes during a well child visit, we may address an illness or problem such as abdominal pain or headaches. Also, sometimes we manage a previously diagnosed health problem like asthma or ADHD. These problems are not a routine part of preventative care and may result in two separate services being billed.
• Depending on your insurance plan, when this happens you may be responsible for a balance (co-pay or deductible).

Billing Process for Well Child Exams

Healthy children need periodic examinations to assess growth and development. The physicians of Central Pediatrics carefully choose which services are necessary for each child. Good preventive care involves necessary screenings to identify and address potential concerns as soon as possible. As a result, well child visits may result in multiple charges. Below are a few examples of services commonly done during a well child visit:

• Physical Examination
• Development Screening
• Hearing Testing
• Vision Testing
• Immunizations
• Cholesterol Level
• Urinalysis
• Blood Count

The services performed will vary depending on the child’s age and other factors. If your child is receiving any of these services from another healthcare provider (such as already having had an eye exam at the eye doctor), let us know at the beginning of your visit. Occasionally, an insurance plan will not pay for some of these services.