Insurance Policy

Forms of Payment

We accept all forms of payments: VISA, Mastercard, American Express, Discover, Cash.

Participating or In-Network Patients

Patients are encouraged to seek care from a “Participating” or “In-Network Provider” in order to receive the highest level of reimbursement under their health plan. As a participating network provider, the provider has contracted with the managed care health plan or “Network” to provide services at a negotiated fee which is typically less than the provider’s billed charge. The negotiated fee or “Contract/Network Discount” is provided to the provider and patient, in a statement referred to as the “Explanation of Benefits”, upon processing of the insurance claim. In addition to any discount, the explanation of benefits will include payment made by the insurance company, any patient amount owed for the services such as co-pays, coinsurance, deductibles and non-covered services. It is important that patients review these statements carefully to insure claims are paid according to the patient’s benefits and plan coverage. The amount noted in the patient responsibility does not include payments already made to the provider for the services. This would mean if the amount shown in the patient responsibility was already paid to the provider, additional payment should not be due to the provider.

Filing Insurance Claims

Well Rooted Pediatrics will file insurance claims for all health plans in which we participate. If we do not participate with your health plan, payment is due at the time services are rendered for treatment in the office and the patient must file insurance for reimbursement.

Filing Your Own Insurance

An itemized receipt is provided at the time of check out. This receipt is required when submitting a claim to the patient’s insurance company for reimbursement. Most insurance companies require a claim form be completed and submitted to the insurance company along with the itemized receipt. Claim forms can usually be obtained from the employer or insurance company by requesting via the telephone or downloading from the insurance company’s website. The address for submitting claims can typically be found on the insurance card or in the plan benefit booklet provided by the health plan.

Insurance Plans Accepted

Please contact our office if you do not see your insurance plan listed below. Please have your card with you at the time of your visit. If we file your claim, you are responsible for only the co-pay at the time of visit. Please check with your insurance provider to ensure that we are in network. Our office does not accept CHIP Medicaid, Medishare, Samaritan or Christian Care put we provide cash pay discounts

Tax ID: 87-4401164

Group NPI: 1063164002

NPI: 1417366436 (Annalise Clayborne APRN, CPNP)

Aetna PPO, HMO, EPO, Managed Choice
Blue Cross Blue Shield POS and PPO, Health Select of Texas
Cigna Health Plan HMO, PPO and Open Access Plus
HealthSmart PPO
Humana-Choice Care PPO
Oscar
Tricare (Non-Network Provider)
United Healthcare PPO, HMO, POS, and Compass EPO
UMR/UHC plans

Newborn or Dependent Changes and Insurance

We understand when a change in dependent status occurs it is likely to be a very busy time in our families’ lives. However, it can be very costly to overlook the requirements of your health plan with relation to dependent changes. It is extremely important to understand this process and time restrictions involved.

Upon the birth of a newborn dependent, adoption or other change to a dependent status, you must contact the employer and/or health plan to add new dependents within the time limits defined by the health plan. Most insurance companies require notification of the change within 30 days from the date of birth, adoption or event date. If you already had dependent coverage prior to the birth of a newborn, adoption, etc., please be advised the insurance company will not automatically add the new dependent to the health plan. Failure to add the new dependent may result in a lapse of insurance coverage for the new dependent, meaning all services provided during the lapse time are the responsibility of the patient. Contact the employer or health plan with further questions regarding this process.

Insurance Referrals and Authorizations

Some health plans require insurance referrals or pre-authorizations in order to receive treatment from a specialist or for special services or medications. It is the responsibility of the patient to know their benefits and request the required referral or pre-authorization prior to receiving the services for which the referral or authorization is needed. It may be necessary to be seen in office prior to submitting a referral for new medical issues or concerns.

Failure to Pay

Continued failure to respond to billing statements or make payments may result in the suspension of certain non-urgent services and ultimately in dismissal from our practice. Please be advised outstanding debts will be forwarded to a collection service where unpaid balances will be reported to the appropriate credit agencies.

Overpayments and Refunds

Should you feel you have made an overpayment to our office or are awaiting a refund based on insurance reimbursement, please contact the appropriate account representative in our Billing Office with questions. If you are entitled to a refund, our office will issue a refund check to the responsible party listed on the account, upon request. Due to the frequency of visits in pediatrics, if we do not receive a specific request for a refund, overpayments are applied as a credit to the patient’s account and applied towards future visits in our office.

Should you have any questions about this summary or any billing issues, we encourage you to discuss it with our Billing Office at 786-522-7842.