Managed Care Insurance
While our first priority is the care of children, we must also adhere to the guidelines and procedures of the managed health care system. We appreciate your cooperation and patience as we try to follow these rules.
Changes in Health Care Coverage
Please notify us of any changes in your health care coverage so that we know where to submit charges to. Failure to do so may result in charges that you will be responsible for. Even if we accept your insurance, we do not have information on your individual policy and its coverage. We ask that parents know their policy and its rules. While we will do our best to assist you, coverage can vary within a given insurer and may change frequently; we cannot be responsible for coverage issues.
Presenting Your Insurance Card
Please be prepared to present your insurance card at each visit. Even if we have scanned your card, it is an insurance company requirement that we ask you to present your card. If a caretaker brings in your child, please give him or her your child’s card. Also, please be prepared to pay your copayment with each visit. An administrative fee will be added if the “copay” is not paid at the time of your visit.
If your insurance company requires that you have a referral prior to seeing a specialist for an elective (non-emergency) visit, we ask that your child be seen by us first. If your child has a medical emergency and needs an insurance referral to a specialist, we can immediately refer. In these situations, most likely your child will have either been seen in our office or we will be responding to your phone call. In general, a visit to a hospital emergency room, if needed, does not require pre-authorization. Please note that managed care companies do not allow us to back-date referrals.
Please remember that failure to follow these procedures may result in your insurance company denying you coverage.
Other Insurance and Billing Considerations
Families with “traditional” insurance will be given an insurance form at the time of your child’s office visit. You can submit this statement to your insurance company. Please save these forms as an additional charge will be made if duplicate copies are requested.
Visits and Your Insurance Company
Willows is committed to practicing the highest quality care based on years of experience and the standards of the American Academy of Pediatrics. The health of your infants, children, and adolescents is always our top priority.
However, every insurance company has different policies about what they consider part of a visit, whether you are being seen for a preventative well care visit, lactation visit, weight check, sick visit, etc. Some insurances will cover everything that we do as part of the visit and some will not, for example; some insurance companies do not cover screenings for vision and hearing, basic in office blood or urine screening tests, or written questionnaires for developmental milestones, postpartum depression, and adolescent anxiety or depression. These screenings may be recommended by your physician, and also recommend by national organizations such as the American Academy of Pediatrics, but your insurance company may elect not to provide coverage. Also, some screenings or visits might require a copay (co-insurance payment) or the charge may be counted as payment towards your deductible, in which case your insurance company will not reimburse you because your deductible has not been met.
Please understand these are NOT rules made by Willows. These are rules made by your insurance company with whom you have a contract. If you have any questions or concerns about something done during a visit in our office not being covered by your insurance company, we ask that you discuss this with your insurance company. We are happy to answer any questions, but whatever service is not paid by your insurance company, parents will be responsible for paying.
If you become aware of something not covered under your insurance plan, and you decide you do not want that service, it is your responsibility to decline the service prior to it being done. Once the service is completed it will be billed and your insurance company will inform us as to who is responsible for payment. If your children/adolescents come to the office alone or with another adult, the same policy applies.
For well care visits please check with your insurance company as to what frequency and timing they allow. Willows strongly recommends yearly well care exams, and these exams can be used for school, sports, and camp requirements. However, all insurance companies do not reimburse for yearly well care. With the vast number of different policies available for each insurance carrier, it is impossible for Willows to know the specific rules for each policy.
We are always available to answer questions or point you in the proper direction to get answers to any concerns you have about your insurance coverage. Please remember, we are here to provide the BEST care possible to your children.
Questions about Your Account
If you have questions about your account, please call our office and press option 6 to reach our billing and insurance department. If you leave a message, please provide as detailed a message as possible so we can respond to your concern efficiently. If you would like to make a payment over the phone, Linda or Julie can check the balance on your account and take credit card payments over the phone.
Please note that there will be an administrative charge for returned checks and copies of billing statements. For families in which parents are divorced or separated, the person who brings a child in is responsible for the insurance copay at the time of the visit. Billing statements are sent to the person who holds the primary insurance.
In an effort to be available as much as possible for your family, we ask parents to call us at least 24 hours prior to a scheduled well exam appointment or four hours prior to a “sick” appointment if you need to cancel. While we understand unforeseen problems arise, a fee may be charged when these guidelines are not followed.
“Emergency” and Additional Medical Forms
You will receive a standard medical form at each well child exam that can be submitted to schools and attached to camp forms. We ask parents to make copies of this form as each child is given one form per year. If you need a form filled out on an “emergency” basis or need additional forms, there will be an additional charge.