COPYRIGHT 2009 Southeastern Pediatric Associates, P.A.

Insurance Participation                                                                        

We participate in the following insurance plans: BC-BS of AL; PMD and Personal Choice; BC-BS of FL and PPC; Private Healthcare Systems (PHCS); Beech Street Corp; CHAMPUS/Tricare Prime; United Healthcare; CCN; CIGNA/Healthsource-Provident; SouthCare (Principal Health Car of Georgia); Health Choice; UNISYS Corp; IBG (Industry Buying Group); First Health. Effective 05/03/2006 our physicians are now providers for the Florida medicaid MediPass program. If you are currently enrolled in the program and would like to change providers, please contact our office or Florida medicaid.

If your insurance has not responded to a claim in 45 days, the claim balance will be transferred to the account balance for you to begin receiving a monthly statement of charges due. Contacting your insurance carrier will expedite payment to our office, but regular payment toward the balance is expected until your insurance carrier makes final payment. Any overpayment of the balance due will be promptly refunded to you. For all other insurance carriers, the superbill can be filed directly by you with your insurance company. It provides all the information needed to allow reimbursement to you for the office charges.

CHAMPUS patients will be billed for any designated non-covered service. A diagnosis will not be changed to accommodate insurance payment. Blue Cross/Blue Shield of Florida to include PPC and CHAMPUS/TriCare will NOT pay for a "sick" visit with immunizations.

Referrals Required by Insurance

For any referral required by your insurance carrier, you must speak to someone directly in insurance. It is your responsibility as the insured to inform the insurance department (during regular office hours) that your insurance requires a referral for an emergency room visit or a visit to any other physician. We cannot make a referral to another physician after the fact. With Blue Cross Personal Choice, you have 48 hours to notify our office for a referral to the emergency room. Any referral requested outside the guidelines of the managed care plan will not be given.

Medicaid Eligible Patients

Medicaid patients must present a current card at the time of service with the child's name and Medicaid number legible. Authorization for treatment must be obtained from the PMP before service is rendered if PMP is other than a physician in this office. Effective 05/03/2006 our physicians are now providers for the Florida Medicaid MediPass program. If you are currently enrolled in the program and would like to change providers, please contact our office or Florida Medicaid.

Hospitalization & Newborn Hospitalization

Following your child's hospitalization, you will receive two or more separate statements: one directly from the hospital, which will reflect hospital charges, and one form our office representing physician charges. Your insurance company requires that you file a separate claim for each bill submitted. Your insurance will be filed for the physician charges of the hospital admission if we have been provided all the necessary information. You are responsible for all incurred charges. We can help you recover some of your insurance benefits by aiding you as you file for reimbursement. Please call if help is needed.

Many insurance policies exclude pediatric charges for newborn care. Maternity coverage may include mother but not the infant. Parents may discover that their insurance policy does not provide the coverage expected for the newborn. Depending on your policy, newborn charges initially not covered might be applied to your major medical deductible.

Outstanding Balance

A minimum payment of $10.00 is expected on all accounts with a balance when a statement is received and/or at the time of an office visit. This regular monthly payment will keep your account in current status and assist you in eliminating the debt. An account balance with no payment in 30 days is considered delinquent. Persistent delinquent accounts will be turned over for collection.