10 Things to Know About Your Insurance Coverage

  1. After your new baby arrives you must notify your employer and your insurance company to add her/him to the policy. The insurance company DOES NOT automatically know this just because they received a claim for the birth. The baby is PRESUMED covered under the mother’s policy for 30 days, but this is pending the baby being added to the plan.
  2. Some Point of Service (POS) and all Health Maintenance Organization (HMO) plans require you to choose a Primary Care Physician (PCP). One of our doctors MUST be listed on the card in order for your insurance company to pay the claim!
  3. PLEASE bring YOUR CHILD’S insurance card to EVERY visit! Often your child’s card will have a different number or suffix and it doesn’t always go sequentially (for example, the subscriber may be 01, spouse 03, and child 07). Even if you keep the same insurance company from one year to the next it is likely that some information has changed like the claims address or network, your benefits, amount of copay, deductible, coinsurance, and out of pocket expenses.
  4. We DO NOT know the specifics of what your specific insurance policy covers and you should understand the details of the plan you have selected. There could be numerous benefits and cost variations your employer has chosen. There are literally dozens of different plans from BCBS, United, Aetna, Cigna, and other smaller insurance networks.
  5. Most insurance policies now have a deductible and/or coinsurance, which may be in addition to your copay.
  6. In general, most policies now cover preventive health visits (check-ups) without a copay, coinsurance, or deductible. However, this does not mean that all services done at the health check are covered. Many insurance companies do not fully cover charges for additional services like hearing/vision screen and hemoglobin/cholesterol testing.
  7. If you want the physician to address any other significant concerns during the health check (like an ear infection, asthma, or ADHD), this will likely NOT be included as part of the health check. This means your insurance company will require you to cover the cost via copay, coinsurance, or deductible.
  8. Our doctors recommend treatments or services that they feel are best for your child: a service (like lactation consultation, a lab test or vision screen), a treatment (ear wax removal), a prescription or referral to a specialist. This unfortunately doesn’t mean that your policy will cover these services. In order to avoid significant out of pocket costs, you should check to see if that service or physician is covered “in network” BEFORE you have the service. Most insurance companies will not go back and reconsider a charge if there was another option.
  9. Your insurance policy is a contract between you and the insurance company. As a courtesy, we will file the claim one time initially with the insurance information you provide at the visit. If the service is not covered, or you did not provide the current information, we are not responsible for refiling the claim and you may be responsible for the entire cost of the visit.
  10. We want to provide the best care we can in the most cost efficient manner to help you get the most from your insurance benefits. Please work with us by providing timely and accurate information. If you know there is going to be an issue please let us know up front so we can work with you.