The Pediatric Place

Patient Balances and Payments   (As of 2/1/2025) We collect co-pays at the time of visit. If your plan is a healthshare, other non-traditional plan, or we are not in network or you are self-pay, we will collect all fees for the visit before you are seen by our medical staff.  If we submit a claim for your visit and there is a patient balance due, your payment is due when your insurance EOB is available and is considered late 21 days after the EOB date. We text and/or email our statements every 2-4 weeks; however, the date we calculate a late fee is the EOB date, not our statement date. A late fee of $10 will be assessed on balances 21 days after the EOB date. Please make sure you have access to your EOBs and understand your patient responsibility. If you’d like to pay your bill before you receive our statement, you can call our billing department 77-640-8119 x5. Or, you can wait for our statement; however, a late fee will be assessed if your payment is after 21 days from the EOB date.  Note about statements: After we generate statements, they are automatically sent electronically and posted on Patient Portal. We do not generate a statement if there is no balance. You can pay from patient portal, your electronic statement, our website, or you can call the office.  You can pay with VISA, MC, Discover or AX. We appreciate your paying your bills promptly!

Basic Insurance Definitions   In recent years, insurers have been passing along more healthcare costs to patients. Most patients are now responsible for copays, large deductibles and co-insurance. To help you understand your out-of-pocket costs, here are a few definitions:

• Co-pay   A fixed amount you must pay at the time of service. It is common for insurance companies to charge the patient a co-pay for most office visits, urgent care visits and emergency room visits.
• Deductible   A fee you must pay before your insurance pays for services. Usually, preventative visit are covered and the deductible fee and copay do not apply. However, this is not always the case. Your insurer may charge a fee for some well-visit services. Deductibles are reset annually.
• Co-insurance   A fee you pay even after your deductible has been met. It is usually a percentage of the service up to a certain amount. It is typical to pay co-insurance for services such as labs, medical tests and procedures. Co-insurance amounts are reset annually.
• EOB  Explanation of Benefits is a statement from your insurance company which itemizes contract rates for the insurance to cover and patient portion to pay.

Billable Well Visits    Most insurance company cover preventative visits (well visits) but will not cover some services they deem as non-preventative, such as wart or molluscum removal, allergies, asthma or an ADHD consult. Usually, your insurance will apply the non-preventative service to your deductible or a shared amount since they are not part of a well exam. We will bill you for these services if your insurance considers them your responsibility.

Your Responsibility with Your Insurance Carrier(s)   We participate with many health insurance companies. Each insurer offers different types of plans with coverage that varies even in the same plan.  Although we make every attempt to understand your coverage, understanding your health insurance policy is your responsibility. Any questions concerning your policy should be directed to your insurer. Your insurance plan decides which benefits are covered in full, which apply to your annual deductible, and whether or not they will allow the benefit and pay for

Multiple Insurance Policies   We need copies of all insurance cards! If you have more than one policy or your child is insured by more than one parent, we must know and you will also need to contact your insurance companies for a Coordination of Benefits to ensure your child’s visits are paid for by the correct insurance. The insurance companies determine which is primary and secondary and you are legally responsible to let both insurances know of other plans. We must file with the primary insurer and if they do not cover the visit, we will submit to your secondary insurer for you. If you fail to comply with our policy, you are subject to dismissal from our practice.

If one insurance policy is cancelled, make sure you update your carriers as soon as possible in order to avoid insurance processing errors. If you have both private and Medicaid policies, private insurance is always primary and Medicaid is secondary. Medicaid may cancel your benefits if you fail to inform of them of your primary coverage.

Responsible Party   Payment is expected at the time of visit. The responsible party will pay the fees for services rendered. You may pay by cash, MasterCard, Visa, Discover or American Express. In the cases of divorced parents, we do not involve ourselves in intra-family disputes regarding the financial responsibility of a bill or account. In cases of dispute, the parent or person who brings the child to the office is considered responsible. All co-pays must be paid at the time of the child’s visit regardless of who accompanies the child. In the event that a friend or relative brings your child to the office, we ask that person to be responsible for paying the bill or co-pay.

As of 2/1/25: All balances not paid within 21 days of EOB date will be subject to a $10 late fee and may be turned over to a collections agency.