We are providers for many insurance companies. Maximizing your insurance benefits and reducing your out-of-pocket expenses is the primary goal of our insurance eligibility department. However, your assistance and personal involvement will expedite the process.
First-time patients to our practice and newborns
If your child is new to our practice or a newborn, you will be asked to present your insurance card, driver’s license and your social security number upon check-in. This information is contained in your child’s chart and is utilized to access your insurance carrier’s data base that contains details about your coverage.
At subsequent visits, our staff will inquire as to the status of your coverage; if there have been any changes or terminations. Newborns should be added to the parent’s policy before their first office visit.
Know Your Plan Beforehand
Taking a personal interest in your medical insurance coverage by coming to your child’s appointments prepared with pertinent insurance documents will aid us in rendering the best possible decisions in the care of your child.
When It’s Out-Of-Pocket To You
Your insurance carrier may have a contract with our office requiring us to provide them specific information before they will reimburse for services your child received. Be aware that insurance is not a guarantee of payment.
Insurance companies deny payments for many reasons. A claim denial may be due to any of the following: a benefit limit indicating your plan’s benefits have been exceeded; a pre-existing condition that your carrier refuses to cover; your plan may have a deductible that has not been met; you have co-insurance or co-pays that are applied to portions of the visits, or simply because a premium payment was not made. These are examples of cases where your child’s medical visits will be an out-of-pocket expense to you.
How Benefit Eligibility Is Hindered
At times due to technological problems our staff may have difficulty contacting your insurance carrier prior to your appointment. Without current benefits you may be asked to pay for the visit in full before seeing the doctor, until benefits can be determined. We will gladly refund any overpayment if your child’s account is clear of any unpaid balance.
Why We Take Care Of Business At Check-in
We prefer to handle as much of the financial aspects of your child’s visit at check-in, because our check-out process already involves prescription forms being properly completed, notes for school absences, scheduling appointments for follow-up visits and more.
Our check-in process also includes advising you ahead of time of any insurance eligibility issues that may affect you financially, before the expense is incurred.
Insurance Companies Contracted
Blue Cross of CA
Community Health Group