Insurance & Billing

Understanding your insurance coverage...

Irondequoit Pediatrics takes most major forms of insurance. We know there are many rules and regulations when it comes to insurance coverage and it can get complicated. We are here to help as much as we can to navigate the system. If you have any questions, just call us. Please refer to information from your insurance provider and the information in our Office Policy found by downloading the following PDF:

Make sure our name or phone number appears on your card or is documented with your insurance company. If your insurance company has not yet been informed that we are your primary care physician, you may be financially responsible for your current visit.

Please try to understand your benefit plan regarding covered services and participating laboratories. For example,

  • Not all plans cover annual healthy (well) physicals, sports physicals, or in office laboratory tests/procedures.  If these are not covered, you will be responsible for payment.

  • For children younger than 2 years, there may be a limit as to the number of allowable well visits per year.  If the number of visits is exceeded, your insurance company will not pay;  you will be responsible for the payment

  • Some laboratory tests that we collect in our office are sent to an outside laboratory.  You will receive a separate bill from them.  We are not responsible for the pricing or billing of these test.

Annual healthy (well) physicals are designated by insurance companies as a visit that includes “anticipatory guidance, risk factor reduction interventions or counseling” and may include addressing minor previous issues; for example, allergies. If major chronic issues, for example, asthma, ADHD, or mental health problems, are discussed and take significant time, an additional office visit may be added to the healthy physical charges. Of course, you can always schedule a separate visit to address these issues.

Financial Responsibility/Billing

According to your insurance plan, you are responsible for any and all co-payments, deductibles, and coinsurances. Co-payments are due at the time of service. A service fee will be charged in addition to your co-payment if the co-payment is not paid by the end of that business day.  A $25 service fee will be charged in addition to your co-payment if the payment is not received by the end of that business day.

Self-pay patients are expected to pay for services at the time of the visit. If we do not participate in your insurance plan, payment is expected from you at the time of your visit. We will supply you with an invoice that you can submit to your insurance for reimbursement.

Patient balances are billed immediately on receipt of your insurance plan’s explanation of benefits. Your remittance is due within 10 business days of your receipt of your bill. If previous arrangements have not been made with our office, any account balance outstanding longer than 28 days may be charged a re-bill fee of $25 for each 28-day cycle. Any balance outstanding longer than 90 days may be forwarded to a collection agency.

For scheduled appointments, prior balances must be paid before the visit unless previous arrangements have been made. We accept cash, checks, Visa, and MasterCard credit and debit. A fee will be charged for any checks returned for insufficient funds.

Miscellaneous Charges

Forms: There is no charge for the Health Appraisal Form given at the time of your child’s visit. This is considered part of the visit. However, should you lose your forms, there will be a $5 charge to replace them.

Transfer of Records: If you transfer to another physician, we will provide free of charge a copy of your immunization record and a summary of your electronic medical record.  The doctor will add additional medical information as needed. We need 48 hours notice. If you require the whole medical record, there will be a $25 fee.  We cannot forward records we received from other physicians.

Missed Appointments: We require 24-hour notice for a change or cancellation of your appointment.  This policy will help us offer the appointment to other patients on our waiting list.  A $25 fee will be charged for missed appointments or failure to follow the above 24-hour notice.

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