© 2018 Sewanee Pediatrics and Adolescent Medicine

1318 University Avenue, Sewanee, TN 37375  |  phone (931) 598-9761  |  fax (931) 598-5038         

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General Information

 

As your Medical Home we not only provide excellent pediatric care, but we will also do our best to work with your family to understand the complexities of medical billing and insurance.  There are hundreds of health insurers encompassing even more insurance plans.  Ultimately, you are responsible for knowing what is and is not covered under your specific plan.   If your plan requires a Primary Care Physician (PCP), please make sure that it is one of the providers or our practice before receiving services in our office.  Our financial policy is designed to make the billing process more efficient and as with any business, we require prompt payments for the services that we provide. We recognize the challenges that health insurance companies create for American families. We pledge to do our best to help you navigate through this confusing system with the goal of providing excellent medical care to your children. Let us know how we can best help you. Please review the document linked below. This requires a parent's or guardian's signature. 

Sewanee Pediatrics Financial Policy Agreement

Insurance Information 

 

We participate with a wide variety of insurance plans.  In order to file claims with your insurance company, we require a copy of your current insurance card. Please notify us if your insurance changes.  We are always evaluating new plans offered to our community.  Let us know if you don't see your plan.

Do we participate with your plan?

Understanding Your Insurance Plan

Questions to Ask Your Insurance Company 

Charges 

 

We have developed our fee schedule to be consistent with usual and customary charges in our community.  Most insurance plans have a negotiated fee schedule with our office.  This reduced fee schedule is what would be your responsibility until you reach your deductible or for calculating co-insurance amounts.  Our negotiated fees with your insurance company represents a contract we have with them.  This prohibits us from further adjusting or discounting deductible, co-payment or co-insurance amounts.   We offer a prompt-pay discount for our self-pay patients and payment plans if needed. 

 

There are certain charges that your insurance may not cover or may be deemed deductible amounts.  These are often office procedures like suturing, wart removal, hearing and vision screening and after-hours, weekend, or holiday services.  If a well care visit also includes an acute care problem or issues that are outside the scope of normal preventative care, your insurance company may charge a copay or deductible for these "additional services."  It is important that you understand what your financial responsibility will be for these services.  Contact your insurance company if you have questions.  

Sewanee Pediatrics does not charge to complete forms or letters.  Often we can get these done for you the same day we receive them.  It is helpful to leave longer or more complicated forms ahead of time.  Occasionally a form will require an office visit to properly complete.  

 

We are available by phone, 24 hours a day, 7 days a week for urgent medical matters at no charge. 

Payment 

 

We require all families who have private insurance or who are self-pay to leave a credit card number on file with our office.  We do not keep the card number in our office, but use a gateway that conforms to banking levels of security.  At no time does our staff have access to your credit card information.  The card will be used to pay for the patient’s portion of services after insurance processing.  After each visit, as a courtesy, we will submit claims to your insurance company.  After the claim is processed, both you and our office will receive an Explanation of Benefits (EOB) from your insurance company detailing your coverage and subsequent responsibility.  After we receive the EOB, we will charge the patient balance to the credit card on file.  If you have questions about your medical bill, you may contact our billing office at 931-598-9761. 

Your plan may require you to pay a co-payment and/or meet a yearly deductible. We expect these payments at the time of service.  Whoever accompanies your child to the office is responsible for payment. We require a credit card on file in our office to pay for the patient balance. We accept cash, checks, VISA, MasterCard, Discover, and American Express.  We also accept Health Reimbursement Arrangements (HRA) cards and Flexible Spending Accounts (FSA) cards that are provided by some employers that can help you pay for qualified expenses related to your health care, including deductibles, copays/coinsurance, and prescriptions.  

 

Co-payments are a contractual obligation between you, your health plan and our practice.  We are not able to modify charges for co-payments, co-insurance or deductibles. More insurance plans are requiring higher deductibles.  Read through your insurance coverage or contact your plan for information about what is and is not covered under your policy.   You will be responsible for payment of services your insurance company does not cover. 

 

We will work with self-pay patients and families experiencing financial hardship and we offer a 20% discount on payments made on the day of services. This does not apply to vaccinations.  Balances left over 60 days, without payment arrangements, will be sent to a collections company and we will need to terminate our relationship with you as your medical home.

Financial Policy 

 

We strive to provide cost effective, compassionate pediatric care for your family. As a courtesy, we will file your insurance for you. In order to process your claim, we will need a current copy of your insurance card. Without your card, you will be responsible for the full payment at the time of service. Whoever accompanies the child will be responsible for payment at the time of service, including copayments and deductibles. We will charge a fee of $10 if the copayment is not paid at the time of service. We will also defer all well child care until all balances are paid in full. We require a credit card to be kept on file at our office. Balances due after insurance will be charged to your credit card. Any unpaid balances older than 60 days, without payment arrangements will be sent to collections and we will no longer be able to provide medical care for your child. You will also be responsible for the additional cost incurred by collecting past-due balances. 

It is very important for us to be informed if you have a secondary insurance company so we file your claim accurately. 

You are responsible for understanding your insurance policy. If your insurance requires a prior authorization, you are responsible for obtaining this and if this is not completed, you will be responsible for all charges. All balances that are not covered by your insurance are your responsibility. If we do not have a contract with your insurance plan, then you will be responsible for all charges at the time of service. We will provide all necessary documentation to submit to your insurance company for reimbursement. 

Self-pay patients will receive a 20% discount if the balance is paid at the time of service. Self-pay patients must pay $50 at the time of check in and the remaining balance at check out. If your visit is less than $50, we will refund the difference. 

A $20 service charge will be charged to your account for all returned checks. All subsequent payments will need to be in cash, money order, or credit card. 

A $20 fee will be charged to your account for all missed appointments. Please see our Financial Policy Agreement for details.