Insurance

While our first priority is the care of children, we must also adhere to the guidelines and procedures of the managed health care system.  We appreciate your cooperation and patience as we try to follow these rules.

Please notify us of any changes in your healthcare coverage so that we know where to submit charges to. Failure to do so may result in charges that you will be responsible for. Even if we accept your insurance, we do not necessarily know detailed information on your individual policy and its coverage. We ask that parents know their policy and its rules. While we will do our best to assist you, coverage can vary within a given insurer and may change frequently; we cannot be responsible for coverage issues.

Please be prepared to present your insurance card at each visit. Even if we have scanned your card, it is an insurance company requirement that we ask you to present your card. If a caretaker brings in your child, please provider him or her with your child’s card or a photo of it. Also, please be prepared to pay your copayment with each visit.  An administrative fee will be added if the “copay” is not paid at the time of your visit.

If your insurance company requires that you have a referral prior to seeing a specialist for an elective (non-emergency) visit, we ask that your child be seen by us first. If your child has a medical emergency and needs an insurance referral to a specialist, we can immediately refer. In these situations, most likely your child will have either been seen in our office or we will be responding to your phone call. In general, a visit to a hospital emergency room, if needed, does not require pre-authorization. Please note that managed care companies do not allow us to back-date referrals.

Please remember that failure to follow these procedures may result in your insurance company denying you coverage.

Families with “traditional” insurance will be given an insurance form at the time of your child’s office visit. You can submit this statement to your insurance company.  Please save these forms as an additional charge will be made if duplicate copies are requested.

Please note that we do not accept any secondary insurances. You will be responsible for filing with your secondary insurance.

Families with “international” insurance will be given an insurance form at the time of your child’s office visit. You can submit this statement to your insurance company. Please save these forms as there is an additional charge if duplicate copies are requested.

Willows is committed to practicing the highest quality care based on years of experience and the standards of the American Academy of Pediatrics. The health of your infants, children, and adolescents is always our top priority.

However, every insurance company has different policies about what they consider part of a visit, whether you are being seen for a preventative well care visit, lactation visit, weight check, sick visit, etc. Some insurances will cover everything that we do as part of the visit and some will not, for example; some insurance companies do not cover screenings for vision and hearing, basic in office blood or urine screening tests, or written questionnaires for developmental milestones, postpartum depression, and adolescent anxiety or depression. These screenings may be recommended by your physician, and also recommend by national organizations such as the American Academy of Pediatrics, but your insurance company may elect not to provide coverage.  Also, some screenings or visits might require a copay (co-insurance payment), or the charge may be counted as payment towards your deductible, in which case your insurance company will not reimburse you because your deductible has not been met.

If you have any questions or concerns about something done during a visit in our office not being covered by your insurance company, we ask that you discuss this with your insurance company. We are happy to answer any questions, but whatever service is not paid by your insurance company, you will be responsible for paying.

If you become aware of something not covered under your insurance plan, and you decide you do not want that service, it is your responsibility to decline the service prior to it being done. Once the service is completed it will be billed and your insurance company will inform us as to who is responsible for payment. If your children/adolescents come to the office alone or with another adult, the same policy applies.

For well care visits please check with your insurance company as to what frequency and timing they allow. Willows strongly recommends yearly well care exams, and these exams can be used for school, sports, and camp requirements. However, all insurance companies do not reimburse for yearly well care.

We are always available to answer questions or point you in the proper direction to get answers to any concerns you have about your insurance coverage. Please remember, we are here to provide the BEST care possible to your children.

If you have questions about your account, please call our office and press option 6 to reach our billing and insurance department. If you leave a message, please provide as detailed a message as possible so we can respond to your concern efficiently. If you would like to make a payment over the phone, we can check the balance on your account and take credit card payments over the phone.

Please note that there will be an administrative charge for returned checks and copies of billing statements. For families in which parents are divorced or separated, the person who brings a child in is responsible for the insurance copay at the time of the visit. Billing statements are sent to the person who holds the primary insurance.

In an effort to be available as much as possible for your family, we ask parents to call us at least 24 hours prior to a scheduled well exam appointment or four hours prior to a “sick” appointment if you need to cancel. While we understand unforeseen problems arise, a fee may be charged when these guidelines are not followed.

You will receive a standard health form at each well child exam that can be submitted to schools, day cares, and attached to camp forms. We ask parents to make copies of this form as each child is given one form per year. If you need additional forms (and you have not paid the Annual Family Fee), or if you need a form filled out on an “emergency” basis there will be an additional charge.