Insurance Coverage

The health insurance industry has changed significantly over the past several years, which has 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 are received.

All co-payments, co-insurance and deductibles are due and payable at the time of service per your contractual obligation with your insurance company.

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 service sand restrictions. We cannot quote coverage or benefits. If you have questions regarding coverage or benefits, please call your insurance company.

Determination of out of pocket expenses is a direct result of your insurance plan’s coverage and the 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, ear wax removals, pulmonary function tests or nebulizer treatments. The specific out of pocket expense or deductible is determined by your insurance carrier’s contracted rates.

If you need assistance, please feel free to contact our business office during regular office hours.

It is important to know the details of your individual health insurance plan. While we have a dedicated staff that can give general guidance, 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.

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.

Many employers offer healthcare reimbursement, as well as healthcare savings and/or flexible spending accounts. These accounts may be in the form of a credit or debit card or may require submission to an administrator for reimbursement via check. Summit Pediatrics accepts credit and debit cards and will be happy to provide you with a receipt if you require one for reimbursement.

Secondary Insurance - 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.

Non-Contracted Insurance - 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 checks.

No Insurance - 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 checks.

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.

Participating Insurance Companies

Summit Pediatrics participates in most insurance plans. The best way to know for sure is to call your insurance company 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. Currently we work with the following: