Billing/Understanding Insurance Coverage

Welcome to the Billing Office at Priority Care Pediatrics, LLC. As a courtesy, we submit your insurance information to your insurance company for reimbursement. Courtesy billing is a service we provide for our patients. Although your insurance has been filed, you will continue to receive a statement until your account is paid in full. You are still financially responsible for any claims that your insurance company does not cover.

On a monthly basis, the guarantor of patients in your household will receive, as necessary, an individual billing statement from Priority Care Pediatrics, LLC. Your initial statement includes information necessary for your insurance company and your personal records. Please keep us updated with your current health insurance information so that our Billing Office can assist you. For billing verification purposes, you should always bring your current insurance card to each visit.

Your health insurance policy is an agreement between you and your insurance company. The policy lists a package of medical benefits such as tests, drugs and treatment services. The insurance company agrees to cover the cost of certain benefits listed in your policy. These are called "Covered Services." Your policy also lists the kinds of services that are not covered by your insurance company. You have to pay for any uncovered medical care that you receive. Keep in mind that a medical necessity is not the same as a medical benefit. A medical necessity is something that your doctor has decided is necessary. A medical benefit is something that your insurance plan has agreed to cover. In some cases, your doctor might decide that you need medical care that is not covered by your insurance policy. Insurance companies determine what tests, drugs and services they will cover. These choices are based on their understanding of the kinds of medical care that most patients need. Your insurance company's choices may mean that the test, drug or service you need isn't covered by your policy.

• Take the time to read your insurance policy. It's better to know what your insurance company will pay for before you receive a service, get tested or fill a prescription. Some kinds of care may have to be approved by your insurance company before your doctor can provide them.
• If you still have questions about your coverage, call your insurance company and ask a representative to explain it.
• Remember that your insurance company, not your doctor, makes decisions about what will be paid for and what will not. Most of the things your doctor recommends will be covered by your plan, but some may not. When you have a test or treatment that isn't covered, or you get a prescription filled for a drug that isn't covered, your insurance company won't pay the bill. This is often called "denying the claim." You can still obtain the treatment you're recommended, but you will have to pay for it yourself (self pay). Your health plan mandates that you are financially responsible for payment of all co-pays, deductibles, and non-covered services. As a provider, Priority Care Pediatrics, LLC is contractually obligated to collect them. Please do not request that we adjust these for your account.

We accept payment methods of American Express, Master Card, Visa, and Discover, as well as personal checks or money orders. You can also make payments over the phone using a credit card if you have the security code.