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).
Our office can’t 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. Also, if you receive non-preventative (sick) services during a preventative (well) visit, additional co-payments, deductibles or co-insurance may incur.
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 can.
- 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.
- 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 we may recommend or render a service your plan doesn’t cover. It could be that your insurance company requires you to use a certain outside lab when we can’t 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’ll 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 isn’t covered or your plan requires you to pay a percentage of the bill.
What plans are accepted?
The current insurance plans we accept are listed below. This list is subject to change, so please contact one of our offices for the most recent information
- Aetna Health Plan (HMO,PPO,POS)
- Beechstreet PPO
- Blue Choice HMO and Blue Choice Option POS
- Blue Open Access HMO and POS
- Blue Choice PPO
- Blue Cross Pathway HMO and POS (as of 2018 this policy will not be on Market Place)
- Cigna Healthcare of Georgia (HMO,PPO,POS)
- Coventry Healthcare and Coventry National (HMO,POS)
- Evolutions Healthcare
- Galaxy Healthcare PPO
- Humana (HMO,POS) **excludes Humana X**
- Life Well (HMO,POS)
- Multiplan/PHCS PPO
- NovaNet PO
- Tricare (Standard only) **excludes Prime**
- United Healthcare of Georgia (HMO,PPO,POS)