At Inwood Village Pediatrics, our number one priority is to provide top-notch quality of care for our families. The information below is provided to assist you and your family in understanding the insurance process, financial policies of our office, and the obligations and responsibilities of the family.

Participating or In-Network Patients

In order to for the patient’s insurance to cover services provided, our physicians must be in-network or a participating provider.  As a participating network provider, the provider has contracted with the managed care health plan or “Network” to provide services at a negotiated fee which is typically less than the provider’s billed charge. It is the responsibility of the patient to know if your provider is in-network with the insurance your present. You can get this confirmation from your insurance company prior to your visit.

Effective January 1, 2020, Inwood Village Pediatrics will no longer be in contract with BCBS HMO. We apologize for the inconvenience. If you have any questions, please feel free to ask a patient representative.

Filing Insurance Claims

Inwood Village Pediatrics files primary insurance claims for all health plans in which we participate. We will not file secondary insurance claims.

If Inwood Village Pediatrics does not participate with your health plan, payment is due at the time services are rendered for treatment in the office and the patient must file insurance for reimbursement. As a courtesy, Inwood Village Pediatrics will file insurance for hospital services, regardless of plan participation. Patient amounts due for all services after insurance will be billed to the patient once insurance has been processed.

Filing Your Own Insurance

A super bill is provided by Inwood Village Pediatrics at the time of check out. This receipt is required when submitting a claim to the patient’s insurance company for reimbursement. Most insurance companies require a claim form be completed and submitted to the insurance company along with the itemized receipt. Claim forms can usually be obtained from the employer or insurance company by requesting via the telephone or downloading from the insurance company’s website. The address for submitting claims can typically be found on the insurance card or in the plan benefit booklet provided by the health plan.

Patient Financial Responsibility Statement

Payment is due at the time of service: For patients without insurance, payment is due at time of service for both sick and well visits. Copays and balances are expected at time of service. After 90 days, outstanding balances will be referred to a collection process. If needed, contact the billing office to work out a payment plan for outstanding or anticipated charges.

Billed services not covered by insurance are the insured’s responsibility, including vaccine charges. Delays in insurance processing occur when correct insurance information is not provided in a timely manner. Such delays may also result in insurance not covering care. Whenever insurance denies payment for a service, it is your responsibility to cover the charges, even while you may choose to review your benefits with your insurance provider.

The patient or adult person presenting with the patient is responsible for satisfying the copay.

Regardless of court decision concerning health care in the case of divorced parents, prompt payment is expected from the presenting parent. Our office considers both parents responsible for payment of services rendered.

It is the patient’s or legal guardian’s responsibility to be familiar with their insurance benefits.

Patient balances should be paid in full or have a payment plan arranged before medical records are sent to another pediatrician’s office.

For complete information, please read our Financial Policy Form.

Newborn and Dependent Changes and Insurance

Upon the birth of a newborn dependent, adoption or other change to a dependent status, you must contact the employer and/or health plan to add new dependents within the time limits defined by the health plan. Most insurance companies require notification of the change within 30 days from the date of birth, adoption or event date. If you already had dependent coverage prior to the birth of a newborn, adoption, etc, please be advised the insurance company will not automatically add the new dependent to the health plan. Failure to add the new dependent may result in a lapse of insurance coverage for the new dependent. All services provided during the lapsed time are the responsibility of the patient. Contact the employer or health plan with further questions regarding this process.

Insurance Referrals and Authorizations

Some health plans require insurance referrals or pre-authorizations in order to receive treatment from a specialist or for special services or medications. It is the responsibility of the patient to know their benefits and request the required referral or pre-authorization prior to receiving the services for which the referral or authorization is needed.

Final Reminder

Please note that payment collected at the time of service may not reflect the full patient responsibility after insurance. Our office is not responsible for any limitations in coverage that may be included in your plan. Should your health plan deny claims for any of the above reasons, you will then become responsible for the bill. It is the responsibility of the patient to pay denied amounts in full. We advise our families to understand their insurance benefits and review explanation of benefits and patient billing statements carefully. If you feel there has been an error, always contact the appropriate party with questions within a timely manner. Anytime the patient is aware there will be a delay in payment, whether by the patient or insurance, it is important to notify our billing office of the situation. Inwood Village Pediatrics understands that circumstances can sometimes arise. However, to allow additional time to pay, work through insurance problems or to establish other payment arrangements, we must be informed.