Insurance

First Things First!

If you are using insurance to cover medical expenses, then you need to make sure your potential pediatrician is accepted by your family health plan. Northside Pediatrics is on a vast majority of plans here in Atlanta so check at the bottom of this page to see if we are on yours.

  • Answers to Your Insurance Questions

    Understanding your insurance coverage isn’t always easy. While it takes a lot of work to learn what will and will not be covered, it is important to understand the details.


    At Northside Pediatrics, we have in-depth knowledge and extensive experience working with innumerable insurance companies. Unfortunately, it would be impossible for us to know all the coverage for every plan for every company (for example, Lockheed’s version of Aetna is different from Home Depot’s version), so we ask that you stay up to date on your coverage details.


    Our office cannot guarantee that all services provided at the time of the visit will be covered by your insurance nor covered under one co-payment. For well checks: vision screening, hearing screening, fluoride treatments, developmental screening, mood disorder screening with the teen questionnaire, lab tests, etc. are considered separate billable procedures which may incur additional co-insurance, deductibles, or may not be covered under your insurance plan.


    All services offered at the well child visit are recommended by the American Academy of Pediatrics well child periodicity schedule; however, that does not guarantee that your insurance company covers the associated cost as part of the well child visit. Also, if you receive non-preventative (sick) services during a preventative (well) visit, additional co-payments, deductibles or co-insurance may be incurred.


    If you have questions about what your plan paid or your bill in general, please call our billing office at 404-705-8990. We want to help in any way we ca

Insurance FAQs

  • What is a “responsible party”?

    When you get a bill from us, as the person who signed to be responsible for the bill, you are the “responsible party”. We are happy to file a claim to your insurance company for each of your child’s visits. Then whatever the insurance company doesn’t pay will be billed to you as the responsible party.

  • Can Northside Pediatrics master the details of my insurance plan for me?

    When you are covered under one of our many contracted insurance plans, we will file claims for your visits. If there are questions regarding coverage, we are available to assist you and see if there are ways we can help with coverage.


    Ultimately though, insurance has very strict rules for which items are covered, over which we have no control. We encourage you to call your insurance plan to discuss any coverage detail questions you may have.

  • Why is it important to know what your insurance plan covers?

    Our providers’ number one concern is providing excellent medical care to your child. Occasionally these recommended services are not covered by your plan. It could be that your insurance company requires you to use a certain outside lab when we cannot do in them in our office. Or we may need to refer your child to a certain specialist.


    In all of these circumstances, you’ll need to know which services, outside lab or specialists are covered by your plan. Typically, insurance companies will not pay for uncovered services, so it is important to be familiar with you plan benefits.

  • How will we work together on insurance and payment issues?

    We are going to ask to see your insurance card every visit. This way we’ll make sure we have the most up-to-date billing information to get your claim paid correctly. If you don’t have your insurance card, you will be “self-pay” for that visit. We will collect the money for your visit the day your child is seen and give you the information to file your own reimbursement claim. We take cash, check, Visa, MasterCard, Discover and American Express. Your copay needs to be paid the day of your visit along with any outstanding balance.


    If you decide not to pay the day of service, we will be glad to bill you; however, a $25 billing fee is added to your account. This amount is not billable to insurance. Most of the insurance companies reimburse us based on a “fee schedule”. This means they pay us an agreed upon amount for our services. They only have us “balance bill” you if a service or part of the service is not covered or your plan requires you to pay a percentage of the bill.

  • What plans are accepted?

    We accept the insurance plans listed below.

    This list is subject to change, so please contact one of our offices for the most recent information.


    • Aetna  
    • Aetna Exchange (Aetna CVS Health Plan) 
    • Aetna Whole Health 
    • BCBS-Anthem (HMO, POS, Open Access, Federal, State Health) 
    • BCBS- Anthem (Pathway X- Guided Access {PCP Required}) 
    • Cigna  
    • Cigna Connect 
    • Cigna + Oscar (Will be terminating in 2026) 
    • Evolutions Healthcare Systems 
    • First Health  
    • Galaxy Healthcare 
    • Humana (Terminated/Closed as of 1-1-2025) 
    • Kaiser- (Multi Choice-PHCS ONLY)  
    • Multiplan 
    • Novanet PPO 
    • Tricare (SELECT ONLY) 
    • United Healthcare  
    • UHC Exchange 
    • USA Managed Care 

    We are NOT in network with the following plans:


    • Ambetter
    • Blue Value
    • Care Source
    • Kaiser HMO
    • Oscar
    • Peach State

    Last updated Dec 2024