Insurance & Financial Policies

Our business relationship with you is an important part of serving as your medical home. Accordingly, we have developed financial policies that we believe are transparent, fair, and patient-friendly.

Guarantor

You will be asked to identify one person who is responsible for coordinating your child’s pediatric care with us. This is the person we will normally communicate with regarding clinical or financial issues, although other adults may be authorized to bring your child to a visit or may carry health insurance for your child. The Guarantor is the person who will receive billing statements from our office. Please note that a divorce decree or other financial arrangement between two parties does not determine who Advanced Pediatrics bills for services. We will bill the appropriate insurance, but will invoice the Guarantor for any balances remaining.

Our Charges

Our charges have been developed to be consistent with usual and customary charges in the community. Payment is expected for all services provided by our staff, including charges for immunizations, in-house lab work, and medical supplies. In an effort to provide the most comprehensive care available to our patients, we make a number of services available to our patients at no cost, including our Nurse Line, After Hours Service, and the completion of most medical forms. Our Nurse Line and After Hours Service can often save you valuable time and money by recommending the most appropriate care for your child.
 

• Please be aware that if any outside lab or x-ray services are required, you will receive a separate bill for those services from the lab or x-ray provider.
• Most well care visits are covered by most insurances. However, some insurances do not cover well care visits and some screenings and lab tests are considered separate billable procedures by insurance companies.
• If a well care visit also includes an acute care problem (for example, if your child has an ear infection that is diagnosed and treated, or if an asthma or ADHD visit is included with the well care, or if the provider consults on issues that are outside the scope of normal preventive care, your insurance company may charge a copay or deductible for these “additional issues.”)
• Please be aware that we charge an additional $50 for urgent visits if we need to interrupt the provider’s schedule to see your child on an urgent basis, and $25 for Saturday acute care visits. Many insurance companies do not cover these additional charges.

Insurances Accepted

We accept most commercial insurance plans, as well as Tricare and Colorado Access (CHP+) although we may not be “in-network” with all plans. We do not accept health discount plans or medical cost-sharing plans.

Copayments

• Many insurance plans require that the patient share in the cost of the visit by paying a copayment. Copayments are due at the time of the visit.
• Certain procedures, labs or screenings may require an additional copayment based on insurance plans. Advanced Pediactics cannot guarantee that all services provided at time of visit will be covered under one copayment.
• The adult accompanying a minor patient is responsible for paying the copayment at the time of visit.
• Non-payment of copayments may result in billing charges, collection activity, and discharge from the practice.

Patients Without Insurance

• Payment in full is due at time of service.
• Patients with no insurance are eligible to receive vaccines within our office from the nationally funded Vaccines for Children (VFC) program, at a cost of $20 per immunization.

We require payment in full at time of service for patients without insurance or if we are unable to verify current eligibility.

• In addition to cash and check payments, we accept VISA, MasterCard, Discover, and American Express.
• We offer a 10% discount for non-insured patients for payment made in full at time of service.

Returned Checks

We have a $20 returned check charge for any checks returned to us by your financial institution as non-paid.

Understanding Your Insurance

To avoid unexpected charges, it is important for you to fully understand your insurance coverage benefits and limitations. Your insurance policy is a contract between you and your insurance company; we cannot modify coverage, copayments, or deductibles.
 

• Please use your child’s legal name for all insurance and medical records.
• If your insurance requires a PCP (primary care provider) or PCM (Tricare), it is your responsibility to designate one of our physicians as your PCP or PCM with your insurance company. We cannot bill your insurance if we are not listed as PCP or PCM.
• In order to bill your insurance company for services provided, it is critical that we have current insurance information in our records. We will ask for your current insurance card at each visit to ensure that our information is correct.
• If you have a deductible or health savings account plan, there may be a patient balance after the insurance company has paid their portion of the bill. We will bill you for this balance due and request upon receipt of your first statement. It is your responsibility to know the benefits and exclusions provided by your insurance plan, including copayment amount, coinsurance, and deductible, as well as the effective and expiration date. Not all services provided by our office are covered by all plans. In all cases, the Guarantor of the account will be charged for any service not covered by the patient’s insurance plan.
• It is your responsibility to make sure Advanced Pediatric Associates is a participating healthcare provider (in network) for your insurance plan. Increasingly, insurance companies have a variety of plans and we may not be in-network with all plans.
• If you have two insurances, we will bill the primary insurance and the secondary insurance. We request that you provide all necessary insurance information to our office and promptly respond to insurance company requests to assist us in this coordination of benefits process.
• Your insurance company may request additional information from you before they process claims. Please respond promptly to these requests. Failure to respond to insurance company requests may result in unpaid or denied claims, in which case the Guarantor becomes fully responsible for these charges.

Past Due Balances and Collections

• If you have a past-due balance on your account, you may be asked to speak to our Business Office when calling to make an appointment. Past due accounts greater than 60 days are subject to third-party action and potential discharge from the practice. Accounts sent for collection action will be assessed a $30 collection charge.
• If you need special payment arrangements, please contact our Business Office at 720-870-4740. We may be able to provide short-term payment plans in emergency situations.
• Our collection policies are fair but firm. We will never deny access to necessary medical services for our patients due to financial issues; however, patients may be discharged from the practice due to non-payment for medical services received.
• If a patient is discharged from the practice for financial reasons (including bankruptcy), we will give 30 days notice and provide emergency care during the notification process. In addition, these accounts may be turned over to an outside collection agency.

 
Please contact our Business Office at 720-870-4740, option #1, with any questions you may have about our financial policies or your account