Insurance requirements:

• Your insurance may require a referral for seeing a specialist.  Please allow 3-5 business days for completion.  We can not email or fax referrals or any medical information so allow time for these to be mailed or picked up.
• Your formulary list with your insurance change constantly and you may not be aware of changes.  Make sure (especially at the beginning of the new year) that your medications are still on formulary with your insurance and do not require Pre-Authorization to fill.  If they do require authorization please allow 3-7 business days to complete this.  Your insurance company dictates this timing and often to do not have a quick turn around time for these requests.

My Bills & Copays

• No copays are required for most preventive care services (or care provided to Medicaid-enrolled children) but lactation services with these preventative medicine visits will require a copay
• Many times parents have extra concerns about their child’s health or behavior that requires extra time and is not part of a routine preventive care visit.    For the convenience of children and families, and when schedules permit, we try to address these added problems as part of your child’s “check up” office visit.   In this situation, as per guidelines developed by the AMA and American Academy of Pediatrics, we will bill for the added office visit time.  Several insurance companies are now asking that we collect a co-pay from families when we address these extra problems in addition to the well child visit.  If more convenient, we can also schedule a separate appointment to address these additional health concerns.
• Our goal is to deliver the very best quality care to your child and family-comprehensive, convenient and fairly priced.
• If you ever have any questions about your bill, please feel free to speak with our billing department at 301-990-1664 option 3 or our office Administrator at 301-990-1664 x111.
• Please arrive early for your appointment. If you are even 5 minutes late for your appointment time, we may have to reschedule your appointment. If you are the last evening appointment of the day (6:30p or 6:40p) on our late days and you arrive late we may have to reschedule your appointment.
• Please complete all paperwork and screenings that are texted or emailed to you ahead of time. These messages may come from our office or from CHADIS. Completing these ahead of time will help to minimize your wait time in our reception area.
• Please bring any medications, prescription bottles, asthma devices and any other pertinent equipment with you to every visit to make the most of your visit.

Your pediatrician is always available to answer quesitons about your child’s care, health and diagnosis.

Financial Policy/Clarification of Charges

• You must present your insurance card and any change in address/phone numbers at each appointment in order to ensure proper billing of your claims.  Failure to provide us with accurate information may result in the patient having to pay for these services at that time or being billed at a later date.
• Federal Holiday, Evening, Weekend and after hour charges may apply in addition to your copay or deductible including code 99051.
• Balances Due: If a balance remains unpaid prior to an appointment, the patient will be required to pay the balance prior to being seen.  In the event a balance goes unresolved for more than 90 days, your account will be sent to collections and the parent/guardian will be responsible for reasonable costs associated with the collection agency, attorney fees and/or court costs.  We reserve the right to charge interest on balances that require multiple bills being sent or balances that remain outstanding more than 28 days.
• Phone Conferences:  We will bill your insurance company for phone calls taking place with a physician during regular office hours in place of an office visit.   This includes but is not limited to ADHD follow ups and/or changing ADHD medications. These phone calls are billed based on the length and content of the call using the national coding guidelines for these codes.  You will be responsible for the balance if your insurance does not cover this charge due to co-pay, deductible, or non-covered.
• No Show Policy:  Failure to give 24 notice of cancellation of an appointment or no-showing an appointment can result in a charge of $60-$165 on the patient’s account.  The fee is subject to change.  This charge cannot be billed to the insurance company. No showing (3) appointments can result in the patient being discharged from the practice at the discretion of the practice.
• After Hour Phone Charge:  Televisits will be billed to your insurance but copays/deductibles may apply.  There will be a $40 charge for each phone call placed to our after hour phone service.  Fees are subject to change.  After hour charges are waived for any child birth-2 months old.
• Assessment Forms:  If your insurance does not cover these forms you will be billed $15 for any assessment forms including, MCHAT, Ages and Stages and Vanderbilt, Depression and Anxiety forms in which our physicians score and assess the results of those forms.
• Routine Exams with Additional Services:  During your well child exams, there are times where additional charges may be warranted because the scope of services goes beyond what is considered routine for that well child exam.  We will bill your insurance company for these charges, but additional copays, deductibles, and fees may apply.  This includes but is not limited to vision and hearing screenings, ADHD visits, acutely ill diagnoses, etc.
• Letters:  There will be a charge for any letters required to be written by our providers including but not limited to special school accommodations, medical necessity, etc.
• Ear Piercing: we offer ear piercing to any child over 6 months old that is up to date on their immunizations.  We have trained nurses to do the ear piercing. The cost is $91 including the cost of the earrings.
• Vision and Hearing Screenings:  We perform Vision Screenings using a special machine using photoscreening to assess any visual problems and a Welch Allyn Hearing Machine.  These tests are NOT usually covered by insurance companies.   There is a $40 charge per screening if the insurance does not cover this service.
• Labs done in house:  Some insurances do not cover the Lipid, Lead, Glucose, Hemoglobin and Total Cholesterol we do in the office.  Please check with our staff for pricing on these services if the insurance does not cover.
• School/Camp/Daycare/Medication Forms:  There is a charge to complete these forms and usually take 5-6 business days.
• Code G2211:
  Understanding Insurance Billing
  When you visit our office, it’s important to know how insurance billing works. Claims
  sent to your insurance carrier must reflect all services provided
  during each office visit. This includes physical exams with additional
  conditions addressed (such as rashes, earaches, coughs, allergies, ADHD, or
  other chronic conditions).
  
  Changes in Coding
  Codes we send to your insurance company are designated
  by the Center for Medicaid and Medicare Services (CMS). A new code – G2211 –
  has been created for primary care providers to indicate that they are following
  patients longitudinally and are committed to caring for the “whole patient”
  over time.
  
  Unlike urgent cares and emergency rooms, Children First Pediatrics takes pride in offering this type of care and is excited that CMS is finally recognizing what we do. As such, we
  will be adding this code to all permitted visits, which currently includes all
  patient encounters except for those designated as “Well Visits”.
  
  Insurance Challenges
  Unfortunately, some insurance companies may not fully
  cover all the services we provide, despite CMS guidelines. This can result in
  denials or passing charges (copays or deductibles) on to patients. While we greatly
  disagree with this, our contracts require us to code for services as
  instructed.
  If you receive a bill for this new code or other codes due to other conditions
  addressed with a well visit, we’re unable to waive the charge. Instead, we
  encourage you to follow up directly with your insurance carrier for
  reimbursement.
  
  Our Commitment to Quality Care
  We take great pride in providing your child with the highest
  quality of care possible. Documenting and coding appropriately for the services
  we provide is necessary for us to continue to serve our families in this way.
  
  Thank you for trusting us with your child’s care!
  
  Accepted Insurances: (and taking new patients up to age 15yrs old)

Carefirst/BCBS
Aetna
Cigna
United
MAMSI
PHCS
Some Coventry Plans
OneNet
Tricare
NCAS
And many more!!

Call and speak to one of our staff members if you do not see your insurance listed here.