All co-payments, co-insurance, and deductibles are due and payable at the time of service per your contractual obligation with your insurance company
Determination of out of pocket expenses is a direct result of your insurance plan coverage and coverage limitations chosen by your employer. Depending on your policy, some services previously paid in full may now carry an out of pocket expense to the member. Services that may be applied towards your deductible include diagnostic laboratory services, such as a rapid strep throat culture or a urine culture, and in office procedures, such as wart removals, cerumen (ear wax) removals, pulmonary function tests,or nebulizer treatments. The specific out of pocket expense and/or deductible is determined by your insurance carrier’s contracted rates.
The health insurance industry has changed significantly over the past several years, which resulted in changes to premiums, coverage types, and out of pocket expenses. Many employers are choosing high deductible plans, which have lower premiums, to offset the rising cost of healthcare. This shifts the out of pocket expense to the employee once healthcare services received.
It is important to know the details of your individual health insurance plan. We have dedicated staff that can give general guidance; however, every plan is different and driven by your employer. Services covered in full under one plan could be applied to the deductible under another plan. If you receive a bill from our office, please feel free to contact our billing office to discuss any concerns you may have.
Summit Pediatrics participates with most major insurance companies and as a courtesy we will file all charges incurred with the appropriate claims office. In order to file promptly and accurately, an insurance card must be provided at each visit.
Today’s health insurance policies offer more options than ever. Each patient is responsible for knowing his or her plan’s benefits package, co-payment, co-insurance, deductible, non-covered services, and restrictions. We cannot quote coverage or benefits. If you have questions regarding coverage or benefits, please call your insurance plan.
Many employers offer healthcare reimbursement, healthcare savings, and/or flexible spending accounts. These accounts may be in the form of a credit/debit card or may require submission to an administrator for reimbursement via check. Summit Pediatrics accepts these credit/debit cards and will be happy to provide you with a receipt if you require one for reimbursement.
Summit Pediatrics is contractually obligated to collect your co-payment, coinsurance, and deductible. Summit Pediatrics will collect $60.00 per visit until your deductible has been met for the year. We accept MasterCard, Visa, Discover, Debit Cards, and personal checks. If you are not prepared to pay your co-payment, co-insurance, or deductible, it may be necessary to reschedule your appointment.
If you need assistance, please feel free to contact our business office during regular office hours. 716.298.1107
As a courtesy, secondary insurance will be billed but only if the primary and secondary insurances are coordinated. The secondary insurance must be presented at the time of service
If we do not participate with your insurance plan, you will be considered a self pay patient and payment is expected at the time of service. We accept MasterCard, Visa, Discover, Debit Cards, and personal check.
Our office will provide self pay patients with a prompt pay discount if your bill is paid at the time of service. We accept MasterCard, Visa, Discover, Debit Cards, and personal check.
Coordination of Benefits:
Your insurance plan will request an update of other insurance information annually. It is the guarantor’s responsibility to provide that information to the insurance plan in a timely manner. Any services denied for failure to update other insurance information will be billed directly to the patient.
Frequently Asked Questions
Q: I received a statement with the note that I should contact my insurance company. Isn’t that your responsibility?
A: Often insurance companies will request information from their members before they will pay a claim. They require that the insured be the one to provide this information and will not accept it from our office. Most often, they have a question about possible other insurance coverage or they want information about an injury to see if any other party is responsible before they pay. Usually, a quick phone call to your insurance company will clear up these questions and they will proceed with claim payment.
Q: Why do I get a separate bill for each child?
A: You shouldn’t. Each child has their own individual account number but should all be listed on one statement. If you do receive more than one, please let our business office know and we will correct the problem.
Q: I received a statement from you showing that my insurance company has not been billed. Why is that?
A: Most often it is because we did not receive your current insurance information while you were in the office. If you did give us a copy of your card and you’re still receiving a bill, it may be because we failed to link your new information to the visit properly. Either way, if you let us know, we can easily correct the problem.
Q: What if my child is in a motor vehicle accident, how will those services be billed?
A: The general rule is that your medical insurance will not be billed as they will not cover any charges that result from an MVA. Some exceptions do apply. We recommend you call your medical insurance and inquire if they will cover these charges. Most often, your automobile insurance is responsible for these charges. Please be aware that you are ultimately responsible for these charges.
Q: Both parents carry insurance for their child, which policy is the primary?
A: All insurance companies follow the birthday rule. The parent whose birthday falls first in the year will be considered the primary insured. We are happy to bill both your primary and secondary insurance carriers provided they are contracted with us to do so. But ultimately, you are financially responsible for any outstanding balances after insurance payments.
Q: How do I know for sure if your doctors are covered under my insurance plan?
A: The best way to know for sure is to call your insurance and ask them directly. We are contracted with many insurance companies so there should be no problem. However, there are times we may choose not to renew our contracts with an insurance company and the information listed on the physician booklet may be obsolete and inaccurate.