Often one of the most confusing aspects of medical encounters has nothing to do with actual medical care, but instead relates to the understanding of your insurance benefits and coverage.

Pediatric Specialists participate in most insurance plans and, as a service to you, will submit claims to your insurance company provided it is one of our participating plans.  We request that any co-pays are paid at the time of service by the individual who accompanies the patient to the office.  Additionally, if you participate in an HMO that requires you to choose a Primary Care Provider (PCP), this must be done prior to your first visit to our office. 

Insurance plans vary greatly with respect to the specific services which are considered covered benefits. Parents often assume we know what their plans cover and what they don’t; however, given the large number of carriers that we participate with, the many different levels of coverage within every patient’s policy, and the changes made on a yearly basis to insurance coverage, it is impossible for us to do so.  Therefore, it is imperative that you know and understand your insurance coverage and benefits, especially with respect to well childcare, immunizations and office visits.  

We cannot overemphasize the importance of being familiar with your insurance coverage because any charges for uncovered services will ultimately be your financial responsibility.  The more you know about the specific details of your plan, the better we will be able to help you maximize the use of your benefits and control your out-of-pocket costs.  We work very closely with our billing company, Advanced Medical Claims, and have found them to be very responsive to questions regarding statements, insurance changes, etc.  They can also provide you with an itemized statement once the claim has been filed with your insurance company.  Please feel free to contact them at (586) 286-1963 with inquiries.  

Lastly, in order to minimize billing errors and confusion, please email a copy of both sides of your insurance card with the subscriber’s name, date of birth and the effective date to us at psbh@myupdox.com.

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Please note we are no longer providing an encounter sheet, procedure codes and detailed pricing at the time

of your appointment.  A receipt of payments made for services provided at the time of your appointment is available to you if you are obligated to pay a balance (i.e. co-pay or deductible).
 

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