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FAQ's - BILLING
1. Why did I get a bill from Pediatric Place?2. Did you bill this to my insurance?
3. What insurance plans do you accept?
4. My insurance did not cover a visit or immunization. Why didn't your office tell me I would have to pay for it?
5. I received a letter from my insurance asking me for my "Other Insurance Information". My child is only covered by this insurance policy. Should I just ignore this notice?
6. The doctor was only in the room for a few minutes. Why did my child's office visit cost so much?
7. What should I do if I cannot pay my entire balance now?
8. Who should I speak to if I have a question about my bill?
9. What types of payment are accepted at Pediatric Place?
10. Is my insurance a "good insurance"?
11. Why was my statement so many pages long?
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1. Why did I get a bill from Pediatric Place?
We only send statements out to parents/guardians when we believe a balance is owed by you. We do not send out "Information Only" statements. There are two common reasons you would receive a bill from our office; either you owe a balance on your child's account or you need to take action in order for your insurance company to process your child's claim.If you owe a balance, the statement will indicate which date(s) of service the balance is for. There are many reasons you may owe a balance including, but not limited to, copayments, coinsurance, deductibles, non-covered services, etc. The exact reason your insurance company did not pay for a service can usually be found on the Explanation of Benefits (sometimes referred to as an EOB) you receive from your insurance company. In some cases, it may be necessary for you to call your insurance company for clarification. Please keep in mind that our office is bound by our contract with your insurance company to collect any balance the insurance company states is your responsibility.
A common example of when you need to take action in order for your insurance to process a claim would be when the insurance company requires an update to your "other insurance" (also referred to as "Coordination of Benefits" or "COB") information. Typically, you can provide this information over the phone by calling the customer service number on your health insurance ID card.
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2. Did you bill this to my insurance?
This is a difficult question to answer because there are many potential variables involved. The short answer is that we file all claims to the insurance company on file at the time of the visit. Therefore, it is VERY IMPORTANT that you provide us with accurate insurance information for your child at every visit. Most insurance companies have strict timely filing guidelines for claim submission. If a claim is denied due to being past the timely filing deadline AND filing was delayed because the correct insurance information was not provided to our office at the time of the visit, you will be held responsible for payment.
If we have valid information on file, we will file the claim to your insurance. In fact, our insurance contracts require that the claim be filed to them by our office. The only time a claim would not be filed to insurance is when we do not have any valid insurance information on file (i.e. you do not have coverage or have not given us a copy of the insurance card). Please communicate any changes in your child's insurance coverage to us immediately.
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3. What insurance plans do you accept?
Our office participates with most major health plans. Here is a list of plans we participate with. If you do not see your health plan listed, please feel free to contact our office by phone at 972-519-0545. There are many smaller insurance companies that we access through our relationships with the larger plans. The most common example would be PHCS PPO which contracts with many smaller insurance companies to provide coverage for its members.Back to Top
4. My insurance did not cover a visit or immunization. Why didn't your office tell me I would have to pay for it?
We do make an effort to avoid these situations. Unfortunately, it is impractical, if not impossible, for our office to know the benefits for each patient's insurance policy. You may be surprised to learn that all policies within the same insurance company do not have the same benefits. For example, our office may know that Insurance A normally covers immunizations. However, your employer purchased a policy with Insurance A that excludes immunizations. As a result, your child's immunizations were not covered by the policy and you are responsible for the balance. In most cases, the benefits of your policy are determined by your employer, and only administered by the insurance company. We cannot stress enough the importance of knowing your policy's benefits and limitations so that you may avoid "surprise" out-of-pocket expenses for your child's healthcare.Back to Top
5. I received a letter from my insurance asking me for my "Other Insurance Information". My child is only covered by this insurance policy. Should I just ignore this notice?
NO! Even though you may not have any other insurance, you still need to call your insurance company at the customer service phone number listed on your insurance card. This is also true if you just gave the updated information to your insurance, and they are asking again. When you call, please make sure to request them to reprocess all outstanding claims after your information is updated. We have seen many cases where the insurance company only reprocesses one claim and leaves others unpaid. Remember that if the insurance company denied the claim pending receipt of this information, they already have the claim in their system. Therefore, it is not necessary for our office to refile the claim. In fact, refiling the claim usually results in the claim being denied as a duplicate submission. If you repeatedly have this problem with your insurance, we suggest discussing the problem with a supervisor at the insurance company and your employer's Human Resources department, if applicable.Back to Top
6. The doctor was only in the room for a few minutes. Why did my child's office visit cost so much?
Medical office visits are not typically billed on a time basis. The level of service billed is determined by three key factors: history, examination, and medical decision making. Time only becomes a factor if more than 50% of the total time is related to counseling and/or coordination of care. We utilize national averages that are adjusted to this geographical area to determine the fees for our services.Back to Top
7. What should I do if I cannot pay my entire balance now?
If you ever find yourself unable to pay your child's balance in full, we simply ask that you communicate this to our billing office in a timely manner. We are happy to set up an acceptable payment plan to assist you in resolving the balance as quickly and comfortably as possible.Back to Top
8. Who should I speak to if I have a question about my bill?
If you have any questions about your bill or child's balance, you can contact our office in many ways. You can speak to the billing staff while in the office, phone the billing staff directly at 972-964-0651, email the Billing Staff, or write to billing staff at the address shown on your statement. The billing office is available Monday through Friday from 08:30AM - 12:30PM and 02:00PM - 04:30PM.Back to Top
9. What types of payment are accepted at Pediatric Place?
We accept cash, check, Visa, MasterCard, Discover and American Express. You can also use your check card if it has a Visa or MasterCard logo. Payments can be made in person, by mail, or by phone if using a credit card.Back to Top
10. Is my insurance a "good insurance"?
We often hear this question each year in the fall when employers begin offering new plans to their employees. Unfortunately, it is not a question our staff can answer for you. Most of our contracts with health plans contain language that prohibits our office from recommending one plan over another. This is in everyone's best interest, including yours.
Our recommendation to parents selecting a health plan is simple. You should select the insurance for your child that best meets your needs. Keep in mind that lower monthly premiums usually translate to higher out-of-pocket expenses. This is particularly a problem if you have children under age 2. Please make sure the policy covers Routine services like Well Child visits and immunizations since these are VERY expensive. As long as the plan in one of the plans we participate with, that plan is a good one as far as our office is concerned. We do not contract with plans that do not meet the criteria our doctors have determined is necessary to continue operating this practice.
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11. Why was my statement so many pages long?
On rare occasions, you may receive a statement from our office that consists of multiple pages for a relatively small balance. We understand this inconvenience; however, we cannot change it at this time. Our computer system prints all activity since your last account statement. Normally, this is not a problem since the majority of parents receive statements every month or so. It becomes a problem when a parent has never received a statement or it has been a long time since the last statement. For example, you have never received a statement and your child is now four years old. You now owe a copay of $15 for which you receive a statement. That statement will include all the account activity for the last four years, and as a result, be several pages in length. We know this is a waste of paper, postage and other resources. Unfortunately, it is not a problem that can be easily and economically corrected at this time. Thank you for your understanding.Back to Top
