Insurance Policy

Pediatrics East of New York accepts new patients and recommends that everyone confirm that we accept their insurance plan beforehand.

We accept the following insurance plans:

  • Aetna
  • Cigna
  • Empire Blue Cross Blue Shield (excluding HealthPlus Plan)
  • Oxford Freedom and Liberty (excluding Metro and Kaleidoscope Plans)
  • United Heathcare (excluding Compass Plan)
  • Multiplan/PHCS
  • 1199 NBF SEIU
  • New York State Empire Insurance
  • Humana Tricare Select plan

(NOTE: we do not accept community based or Medicaid affiliated plans).

Copay

Copays are collected at the time of the service (ie, sick visits). Outstanding copayments will be subject to a $50 service charge. If your account is past due we may use the credit card on file or be forced to send the account to a third party collections agency.  We will attempt to contact you first and make every effort to work with you so a payment schedule could be set up for the account. If you have switched insurance plans, it is your responsibility to provide the updated information at your earliest convenience to our billing staff to avoid potential billing and appointment scheduling conflicts.

Online Payments

For your convenience, our practice offers a secure way to pay your balance online through InstaMed.  Payment options include Mastercard, Visa, and Discover.

Primary and Secondary Insurance/Health plans

Children and adults can be covered under more than one heath plan. When you’re covered under multiple health insurance plans, the plans will have to coordinate you and your children’s benefits, this is one of the reasons a health plan wants to know if you or your spouse has any other coverage and will contact you on a yearly basis to establish co-ordination of benefits.

To prevent payment problems, when children are covered under each parent’s group health plan, one plan must be designated as “PRIMARY” and the other “SECONDARY.”  This must be verified with the insurance carriers to avoid problems. The plan that is primary pays the claims first. The secondary plan pays any remaining costs not covered by the primary plan dependent on the benefits of the specific policy-but only if the medical care is a “covered benefit.”  If both of your insurance consider themselves to be PRIMARY or consider themselves SECONDARY, then neither will cover your services. As always, insurances will not reimburse you for services they do not cover.

Failure to provide proper insurance information may result in your carrier refusing payments for the services provided by the practice on your behalf. If such the is the case, you, the member, will be held responsible for any unpaid balances. We urge you to call your insurance carriers for further details regarding their policies and to be sure which consider themselves PRIMARY and which is SECONDARY on your behalf.

Birthday Rule Determines Health Insurance Coverage

Under the birthday rule, the health plan of the parent whose birthday comes first in the calendar year (by month and day, not year) is the primary coverage for your children.  If you do not wish it to be the case, please contact your insurance carrier to switch the designation.

Referrals to Subspecialists

We ask you to contact our office staff if you need a referral for any specialist visits. We are NOT responsible for referrals called in after the specialist visits, as the insurance carriers have set time limits on the creation of the referrals. For example, Oxford insurance gives a 72hr window.

For further information, please contact our office ask for billing or email billings@pedsoneast.com.