Billing Policy & Billing FAQ's

 

Payment and Insurance Policies for Black Rock Pediatrics

 

We have received several common questions regarding billing for medical care and we are moving forward to try to clarify our payment policies. Black Rock Pediatrics is an extremely generous practice in that we accept many insurance plans of all types.

We hope to help clarify some of the billing issues below.

1. Why am I being charged for this service and why is it not covered in my plan?

This is a common question we get, sometimes with frustration or anger directed toward us. We are incredibly generous in taking a broad range of insurance plans. Many practices refuse to take certain insurance plans because they pay doctors poorly, but we have always tried to take every insurance possible to try to help our patients. Other doctors do "concierge care" or take no insurances at all because that is much better financially for the doctors- and it certainly is less frustrating. We have chosen not to make any of these choices and have always offered great care with insurance coverage. If you are not happy with your plan or are confused about the coverage in your plan, you need to call your insurance company directly to complain to them about the service. It is each family's responsibility to find out about your insurance from your insurance plan. If you dislike your insurance in terms of what it does and does not cover and prefer to go to a doctor who does not take insurance, there are many options available.

2. Why did I receive a bill from Black Rock Pediatrics several months after the appointment?

You only receive a statement from us if there is a bill to be paid to us by you. After a patient is seen, we send the statement to the insurance company. There is often a long period of correspondence between us and them to determine what the insurance is paying and then what the patient would owe after that. You are being billed for the patient responsibility. We submit to the insurance within the week of your appointment, but unfortunately, insurance can take weeks to months to reconcile what they pay and what the patient then owes. Often there is also information that needs to be added or changed for the insurance company requiring prolonged correspondence. If you get a statement from us stating "patient responsibility", it means that we have already been corresponding with your insurance company up until that point and the insurance company is requiring the billed payment to come from the patient. This amount is determined by your plan. If you are not happy with your plan's requirements, you need to address your complaints with your insurance company.

3. I don't understand my billing statement?

Statements can be confusing. The payment due to Black Rock Pediatrics is stated as "patient responsibility". The other information includes the details of the visit and what the insurance paid. We have a policy of circling or highlighting what is due to clarify exactly what should be paid by the family to Black Rock Pediatrics. The part on a statement from Black Rock Pediatrics that states "Patient Responsibility" is money owed to be paid to Black Rock Pediatrics by the patient. That amount is based on how your policy is structured. If you are not happy with what your insurance is requiring for patient responsibility, you should call your insurance company to discuss that complaint with them. You should also regularly be receiving an "EOB" or "Explanation of Benefits" from your insurance company to explain what is covered and what is not according to your own policy- which you have chosen. We have attached a sample billing statement with the amount highlighted. The highlighted amount should be paid to Black Rock Pediatrics.

4. We see that we have owed you money for a long time, but we are arguing with our HR department or with our insurance company.

We have some bills that have been outstanding to us for many months or even years. This bill is due to us. If you have an issue with your insurance company or with your HR department at work, we give you ample time to work it out, but we are not able to carry each individual's personal disputes that you have with your own company HR department or with your own insurance company as a prolonged loan for months to years on our expense. We ask that you please settle your bill with us and then continue to argue if you would like to for reimbursement from your work or insurance if they have a dispute. If they do eventually pay us, we can easily reimburse you for the amount.

5. Why am I being charged for a well visit?

While many insurance policies pay 100% for a general annual well exam, there are other components to a well exam that may result in a patient balance because your own policy does not cover those components. For example, your policy may require that you pay for a hemoglobin test, a urine test, or a hearing or vision screening test. Those rules are not set by us, they are set by your policy that you have chosen. We are responsible to provide standard of care for health care and we cannot control what contract your policy has. Also if an illness is addressed during the appointment of the well physical, your policy may require that you pay a copayment because there was a sick visit component which had to be addressed and treated. These are not our ideas, they are based on the insurance you have chosen to contract with.

6. I forgot to update my insurance and my old insurance plan was billed. Can this be billed to my new active insurance?

This is a common question we get. The practice is happy to submit claims to your insurance on your behalf, but please realize that a physician can only submit a legitimate claim during a window of time which is called "timely filing". The window of time is dictated by your own insurance plan- not by us. It is absolutely the responsibility of every patient to provide us for the active insurance on the date being treated. If you have not given us the correct insurance within the window required by your insurance company, then we cannot do anything about that and the patient will be responsible for the balance. If you provide us with the appropriate active insurance on the day of service within the required amount of time, then your insurance can be charged. It is your responsibility. Giving the wrong insurance card is the same as giving an expired credit card or a bounced check. It is useless to us to use toward your billing. If you then receive a bill from us because the amount was not able to be paid by your insurance because you did not give the correct card at the time of the visit or within the amount required by your own policy, then you would be responsible for that bill.

Fortunately, technology is catching up and will be able to help us. In the coming weeks to months, we will have a new system which will allow us to check at the time of your visit whether the insurance you are listing is active. If it is not an active insurance, we will be requiring a credit card on file until the active insurance is received because inactive or incorrect insurance does not provide any payment for the visit. As always, the insurance will have to be updated in the timely window required by your own chosen policy in order to apply that insurance. If the insurance is updated correctly within the timely filing period, the credit card can be removed from file.

If any family in our practice is experiencing financial hardship and is unable to pay the bill, we always have and always will be willing to work out a fair payment alternative. Please feel free to directly contact your doctor or our billing department (whichever is more comfortable for you) if you need to arrange for an alternative payment plan. Our priority is to care for the families in our practice and if you need help from us please allow us to try to accommodate for you.