Billing and Insurance

As we are all aware, health insurance has become much more complicated. Centre Pediatrics currently bills to many different companies with many different plans. Some of these are “managed” and some are not. The options and coverages for these plans vary so considerably and the number of plans, even within one company, is so numerous that we cannot keep track of the details of the various plans. We urge you to become familiar with your insurance so that you understand its rules and coverages and know whether well visits, immunizations, laboratory charges, and sick visits will be covered.

It is very important that you bring your child’s insurance card to our office each time that you visit. All insurance companies have time limits for billing claims and the HMO plans especially have strict and short filing limits. If the information that we use for billing comes directly from your insurance company via your child’s card, we have much better success in meeting those filing limits and thus avoid transferring the claims to you.

Here are a few tips. We hope these will help you in ensuring that your company pays the claims submitted by us on your behalf. If you follow these, we believe that you and we will avoid common problems:

  1. When you have a baby, call your insurance company right away and inform the customer service representative that you want to:
    • add your new baby to your policy, effective as of the date of birth and
    • designate a Centre Pediatric doctor as your baby’s PCP (primary care provider) effective as of the date of the baby’s birth.
  2. Write down the name of the representative with whom you speak and the date of the conversation so that you can refer back to that information if you need to.
  3. If the customer service representative gives you an ID number and/or a suffix number (which some insurance companies require and some do not), write that down carefully, but stress that you want the card as soon as possible.
  4. As soon as you receive your child’s card, examine it to make sure that the information is correct. You may need to add your social security number and signature to the back of the card.
  5. Once the card has the correct information, make a copy of both sides of it, put your child’s name and date of birth on the copy, and send it to our office, to the attention of the billing department. Or if your next visit is in the near future, bring the card with you and we will copy it.
  6. If you change insurance, please notify us as soon as possible with a copy of your new insurance card(s), and the effective date of the new policy. Click here to inform us about any changes in your insurance. And don’t forget to designate a PCP for your child with your new insurance company.
  7. We will only send you a statement for balances that are your responsibility. If you have questions about our statements, please call us right away. We may be able to re-bill your insurance company, but since some insurance companies have strict filing limits, we need to deal with any problems as soon as we can.
  8. Most insurance companies will send an EOB (Explanation of Benefits) to you about the claim that the company is or is not paying. If you do not understand it or have questions, call your insurance company as soon as possible.

We hope that these few tips will facilitate the billing to your insurance company.