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Insurance & Policies
In order to accommodate the needs and requests of the patients,
Northside Pediatrics has enrolled in numerous managed care insurance
programs. We are pleased to be able to provide this service to you, but
it is impossible for us to keep track of all the individual
requirements. Each plan has different stipulations regarding how often,
where, and by whom medical services may be rendered. Even within the
same insurance company, the plans differ with the type of contract you
or your employer have negotiated.
Providing quality medical care for our patients is our primary
concern. Please make every effort to become familiar with the benefits
of your plan. We may recommend or render medical services that are not
covered by your insurance plan. For example, should your insurance
carrier require you to use a specific lab or other outside facility, it
is your responsibility to inform the nurse. Failure to do so
may result in charges to you which your insurance company does not
cover. Most managed care plans require that we receive authorization
for referrals to a plan's list of subspecialists. These authorizations
must be received well in advance of your appointment with the
subspecialist. If a subspecialist 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 that we provide which
may not be covered by your plan include counseling for behavior or
learning problems, including ADD, extended telephone conversations, and
written correspondence. You will be billed for these services directly.
Again, please make every effort to become familiar with the benefits of
your plan.
Most insurance plans reimburse us a contractually agreed upon
discounted amount for our medical services. We can not, and will not,
"balance-bill" you for these services, if we hold such a contract with
your insurance company.
You are required to pay for office visits or co-pay by cash,
check, money order or credit card. Please be prepared to pay at the
time of the appointment. Should you have any past due outstanding
balances, this will be collected before you are seen by the doctor, as
well as co-payments that apply. A copy of your insurance card is
required.
If there are any questions regarding a bill, please call our Central Billing Office at (404) 705-8990.
These are plans in which the physicians are currently members:
- 1st Medical Network (a.k.a. GA First/MRN)
- Aetna (HMO, PPO & POS)
- Blue Cross Blue Shield (HMO/POS, PPO, Blue Direct, Blue Open Access)
- Beechstreet (PPO)
- CCN
- Champus/Tricare PPO (Standard Only)
- Choice Care (PPO Managed by Humana) - (f.k.a. Employers Health)
- Cigna Healthcare of Georgia (HMO, POS & PPO)
- Coventry Healthcare (HMO and POS) - (f.k.a. Principal)
- Evolutions Healthcare System (PPO) - (f.k.a. Guardian Resources)
- First Health (PPO)
- Galaxy Health Network
- Great West Healthcare (PPO, HMO, POS) - (f.k.a. One Health Plan)
- Health Network of America (PPO)
- Humana (POS and HMO)
- Kaiser (POS Only)
- Lifewell Health Partners
- Nova-Net (PPO) - (f.k.a. Special Net)
- PPO Next (PPO) - (f.k.a. Preferred Health Network & Healthstar)
- Private HealthCare Systems PHCS (PPO Only)
- Preferred Plan of Georgia (PPO)
- Southcare (PPO) - (f.k.a. Principal/a.k.a. Coventry)
- Unicare (PPO)
- United Healthcare of Georgia (POS, HMO & PPO)
- USA Managed Care Organization (PPO)
The above list is subject to change. Please call the office for up-to-date information.
Policies
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