The billing department at Annapolis Pediatrics has extensive experience and knowledge in dealing with both managed care and traditional insurance plans. Patients rarely get the opportunity to meet these wonderful staff members in person, but they are available to help you if you have a general question about your insurance or questions about billing statements you may receive from our office. They can be contacted at 410-263-6363, option 7.
Health insurance is important to all of us, but can be difficult to understand. The benefits, rules and restrictions are determined by the terms of your policy, as well as the contracts Annapolis Pediatrics has with various insurance carriers. Please remember that your insurance policy is a contract between you and your insurance company. Although we accept many different insurance plans, coverage varies from plan-to-plan and our billing department may not know the exact details of your coverage. If you feel that you were billed for services that should have been covered by your insurance, you should first contact your insurance company.
After the birth of your new baby, be sure to fill out the necessary paperwork to add your baby to your insurance policy. Most insurance companies allow 30 days from the date of your child’s birth to send in the paperwork. If you miss the deadline, claims filed on behalf of your newest family member will be denied and you will have to wait until your next open enrollment period to add him or her to your policy.
Don’t schedule your child’s physical exam on his or her birthday. Many insurance providers don’t consider it a “5 year-old physical” until the day after the birth date.
For annual physical exams, many insurance companies do not cover two physicals within a one year period. Please check with your insurance company to verify coverage for physicals if you have questions.
All patients are responsible for presenting their current primary and (if applicable) secondary insurance cards at every visit. Co-pays are due at time of service. If you do not have evidence of current insurance with one of our doctors as primary care provider, or if your child is not covered under any insurance, you will be required to pay in full for services at the time of your visit. Patients will be required to complete a new Patient Registration form each year, and whenever their demographic and/or insurance information has changed.
Understanding Insurance Information & Terminology
- an amount that must be paid out of pocket before the insurance company will pay any expenses
- percentage you are required to pay, after the copay and deductible, of the allowed amount for a service
- “Birthday Rule”
- Insurance companies follow what is called the “birthday rule” if more than one insurance. This means the primary policy is held by the person with the birthday month that falls first in the year. This excludes Medical Assistance and Tricare which always default to secondary.
- It is very important that the primary care physician is one of our doctors or states Annapolis Pediatrics. If not it could mean a higher copay for you or claims not being paid. Annapolis Pediatrics can not update this for you.
- Some insurance companies require accident details to process a claim. This is most likely a form that is to be filled out and sent back to them.
Important Insurance Reminders
- Most insurance companies do not cover newborns unless they are added to the policy
- Any additional services other than the office visit, such as burn treatments, penile or labial adhesions, ear wax removal, wart removals, suturing or cauterizations are separate billable codes and could be put towards the deductible.
- If the patient has more than one insurance company it is important that they are aware of each other. This is called a coordination of benefits.
- State of Maryland employees need to be aware that their employer does not automatically cover their newborn from the date of birth for first time parents. A retro form and payment will need to be submitted for State of Maryland employees. These employees should contact their Human Resource department for more information. If these employees have other children and are on a family plan this step should not be necessary.
- Applying for Medical Assistance or for coverage through the Maryland Health Exchange is done online at marylandhealthconnection.gov. If you do not get a response within two weeks of submitting the application, please check your emails to see if there was a problem.
Missed Appointments/Late Cancellations
We kindly ask that you give us at least 24 hours notice when cancelling an appointment.
Missed appointments may result in fees:
- Routine appointments (well or sick) that are missed, as well as those that are not cancelled at least 24 hours before the appointment time (2 hours for sick appointments), may result in a $25 fee.
- Missed behavioral health appointments may result in a a fee of $50 for any cancellation without 24 hour notice.
Co-pays and Outstanding Balances
Co-pays and outstanding balances are collected at the time of service. We accept cash, check, VISA, Mastercard and Discover. There is a $6.00 fee for returned checks.
School, Sports, Camp, Daycare Forms
Because of the increasing demand, complexity and length of time it takes to complete them, it is very important that you bring your form to us as soon as it is received. Parents should complete their portion of the form in advance. The fee for standard processing of a form (7 to 10 business days) is $7.00. The fee for “stat” processing of a form (24 to 48 hours) is $20.00. Please complete the Request for Forms Completion and submit with your form.
In the state of Maryland, the physician who creates the patient’s medical records is the owner of the records and is permitted to charge a processing and copying fee. Annapolis Pediatrics charges a standard processing fee of $25.00 per child per copy. This fee must be received before records will be released to you or your child’s new physician. Upon receipt of fee, requests for release of medical records will take up to 14 business days to process. There is no fee for request for immunization records. Any medical record for a patient 18 years and over must be requested by the patient. Please complete the Authorization to Release Protected Health Information (PHI) form. This form may also be used by patients transferring into our practice to request medical records from their previous physician.
The need for a written referral varies by insurance carrier. Should you require a referral to see a specialist you must first schedule your appointment with the specialist before a referral can be issued. We ask that you allow a minimum of 48 hours to complete your referral. Contact our referral line at 410-263-6363, option 6. Please be prepared to provide us with the specialist’s name, address, telephone and fax numbers, reason for visit and date of appointment. Referrals can be faxed, mailed or picked up in the office.
After Hours Triage Calls
After hours, our on-call nurse triage service will help you in a medical emergency. When you call the office number, you will get transferred to our triage service and your call will be promptly returned. The triage service has access at all times to one of our physicians. You may incur a $15 fee for this service.