Appointments: 540-347-9900
20 Rock Pointe, Warrenton, VA 20186

Insurance

Policy-Financial

As we enter this doctor-patient (parent) relationship, we agree to provide quality pediatric service at a fair and reasonable price. You in turn, agree it is your obligation to be prepared to pay at the time of service and to understand the benefits of your insurance for physician office visits and any hospitalization if necessary. We want to explain our Financial Policy to you so there are no surprises.

Our billing office is available during regular office hours to discuss our charges, insurance questions, the status of your account, facilitate referrals, or to help you with any billing or insurance questions. You may call the Billing Office directly at (540)347-4500 or press (5) on the office line. Thank you for understanding our financial policy and please keep our records current with any changes in address, phone number, guarantor, or insurance information.

The practice of medicine has changed drastically since the 1990s. Managed Care (HMO) plans play an increasing role in determining the panel of physicians, the hospitals, the lab and/or x-ray facilities from which patients may receive care. Often there are insurance limitations on what your carrier will pay and what you are responsible for. We understand that insurance plans can be very complicated and difficult to understand. To help you, we will submit claims to all insurers whether we are a participating provider with that insurer or health plan. We will do this in a timely manner as a courtesy to you. We do not file claims to secondary insurances.

Since our patients are insured with hundreds of different insurers and health plans, we will need your help as well. When it comes to filing claims so your visit is covered or properly reimbursed, we need to get the right information from you. We have found that at least 25-50% of our patients will make a change at some point that will affect their health insurance and reimbursement. If you do not report that change to us, the correct information is not sent to your insurance and health plan. Then you and our billing staff will find your visit not being covered and will spend a lot of time finding the problem, resubmitting your claim, and waiting for reimbursement. To prevent this from happening our front office staff will ask you to update your information at each visit, and will ask you to present your insurance card for verification. We must have a correct policy, group identification and/or claim numbers, etc., along with a correct billing address. Please let us know as soon as possible if you have any change in insurance, employment, address or phone number.

Insurance

Your insurance policy is a contract between you and your insurance carrier or HMO. Piedmont Pediatrics is not a party to that contract. We must emphasize that as your child’s healthcare provider, our relationship is with you, not your insurance company.

  • Please understand the benefits your insurance or health plan provides for physician office visits. It is your responsibility to know what services are covered. If you are unsure check with your employer or call your insurer.
  • Present your insurance or health plan card at each visit. This will allow us to maintain accurate billing information.
  • Please register your newborn infant on your insurance plan as soon as you are discharged from the hospital. Generally, in-office care for your newborn is not covered by insurance until the infant is officially registered on your plan. This should be done before your infant is 30 days old.
  • Please familiarize yourself with your child’s specific insurance plan and your out-of-pocket expenses, such as co-payments, co-insurance, deductible, and any non-covered services. Most insurance and HMOs require that a co-payment be made at every office visit.
  • Not all services are a covered benefit in all contracts. It is your responsibility to be aware of your insurance company’s provision for payment of office visits, immunizations, well-child exams, and routine annual exams including school, camp, or sports physicals.
  • Please remember that you are responsible to pay any charges NOT covered by your insurance such as deductibles, co-payments and non-covered services at the time of your visit. For all immunizations, Piedmont Pediatrics reserves the right to balance bill any difference between insurance company reimbursement and the actual cost of the vaccine. We do not make money on vaccines, but in order for us to continue to provide this service to our patients we must recoup our cost. Full payment of non-covered services is expected at time of service.

Insurance Participation

Piedmont Pediatrics has participating agreements with most all insurances, including the following:

Aetna HMO/PPO
Anthem HealthKeepers
Anthem HealthKeepers Plus
Anthem PPO
CareFirst PPO
CareFirst HMO
Cigna HMO/PPO
First Health
Great West
InTotal Health
MAMSI/MDIPA
Medicaid
NCPPO
One Net (Alliance)
PHCS
Southern Health
Tricare Standard
United Heathcare
VHN


We DO NOT participate with Virginia Premier. If you are eligible for Medicaid, please be sure you select a plan we participate with.

Payment Procedures

  • To help keep your medical costs down, payment is due at time of service. For the convenience of our patients we accept cash, checks, and Visa/MasterCard. For any co-pay not paid at time of service you may be assessed an additional charge of $10.00.
  • It is our office policy to bill insurance plans in which you participate as a courtesy to you. Nevertheless, YOU are responsible for payment regardless of any insurance company’s decision to deny coverage or to reimburse less than our charge.
  • If both parents have health insurance, the parent with the first birthday of the year is most often the primary insurer. Please check you insurance policy to determine which plan is primary before your appointment.
  • Since most patients we see are minors (under age 18 years) we consider the parent/guardian accompanying the child as the responsible party, unless other arrangements have been made. Piedmont Pediatrics does not get involved with custodial disputes-we are advocates for the child.
  • Any patient who is a young adult (over age 18 years) is legally an adult and responsible for his/her medical costs. We will honor the parent’s insurance if the patient is still covered (usually college students).
  • If you are having a financial problem paying for medical services, we are willing to work with you. Please contact the Billing Office to arrange an extended payment plan to help you meet your obligations. When you agree to an extended payment plan, we expect you to pay your monthly payments as agreed on. You may be asked to leave a credit card number on file, so that a payment can be applied on a monthly basis.

Collection Policy

  • Any accounts over 90 days with no payment activity or any attempt to pay or contact the Billing Office may be turned over to our collection agency. Please don’t ignore your statements; please contact us to help you meet your obligations. Bad debt is reportable to the major credit agencies.
  • If your account is currently in collection status, all future services will be on a CASH BASIS only and will be limited to sick visits only. If your account with collections is not paid by 6 months, you will be discharged from the practice.
  • Any patient who has been transferred out or was discharged from the practice due to a billing problem will be required to pay the previous balance prior to being seen again.
  • If you have a previous outstanding balance for hospitalization or other bills and get a new insurance to cover your current charges, you are still responsible for the previous outstanding balance and may be subject to collection if not paid, despite the new insurance.