Insurance & Financial Info

Due to the continuing changes in the healthcare industry, we would like to provide you with our practice billing policies and how they relate to you.

Please be advised that this is a private practice setting; and although we bill many insurance companies, the parent or legal guardian who brings the child to the appointment (unless the child is over the age of 18) is responsible for any charges.  Our office participates with the following health insurance companies*:

  • Aetna Health Plans – please call Aetna for specific plans
  • Beech Street
  • Benefit Planners
  • Blue Cross Blue Shield – please call BC/BS for specific plans
  • Community Blue
  • Community Blue Child Health Plus (For existing patients only.)
  • Community Care (BCBS Medicaid Managed Care for existing patients only.)
  • The Empire Plan
  • FidelisCare New York (Medicad Managed Care)
  • Fidelis Child Health Plus
  • First Health
  • Health Net Federal Services (Tricare Region One only – please call plan to verify. For existing patients only.)
  • Independent Health Association
  • The Loomis Company
  • Medicaid (New York State only. For existing patients only.)
  • Medicaid Managed Care (Panels are currently open for Fidelis only.)
  • Meritain
  • Multiplan – please call MultiPlan for specific plans.
  • Nova Healthcare
  • PHCS/Cigna
  • Southern Tier Building & Trades Benefit Plan
  • Tricare – Region One (For existing patients only.)
  • United HealthCare
  • Univera
  • Univera Community Health (For existing patients only.)
  • Univera 4Front
  • Univera PPO

*If you do not see your insurance carrier listed, please call our office. This is only a list of the most common carriers that we bill. Please check with our office to see if we are accepting new patients for your specific plan. This list is subject to change without notice.

LAB WORK AND HOSPITAL PROCEDURES:  Please be advised that many insurance companies require you to go to a certain lab and/or hospital.  YOU will be responsible to pay your bill if you go to a lab and/or hospital that is not covered by your insurance carrier.  Please check with your insurance company to see where you should go for these services.

Our providers have admitting privileges at WCA (Women’s Christian Association) Hospital of Jamestown, NY. You may be referred to WCA Hospital for admission, laboratory, anesthesiology, pathology, radiology and/or surgical services. Upon arrival at WCA, we recommend asking for the name, practice name, and telephone number of any health care provider scheduled to perform these types of services, as we do not typically have that information upon referral. Occasionally, patients are referred to another facility (such as a children’s hospital) for  laboratory, anesthesiology, pathology, radiology, and/or surgical services. Again, we urge families to contact the hospital to get the name(s) and information for any health care provider scheduled to perform any of these services in order to ensure that insurance will cover such services as we do not always have that information at the time of the referral.

FOR EXISTING PATIENTS, IF WE DO NOT PARTICIPATE WITH YOUR NEW INSURANCE CARRIER:  The parent/legal guardian (or patient if over 18) is responsible for payment in full at the time of service, with no exceptions.  We will gladly provide you with the necessary information for you to submit the claim to your insurance company for reimbursement.

INSURANCES THAT REQUIRE PRIMARY CARE PHYSICIANS:  If you have an insurance company that requires a Primary Care Physician to be chosen, it is your responsibility to be sure that it is correctly listed.  We will not be able to see you at the scheduled time if the PCP is not correct.

APPOINTMENTS:  If you are unable to keep an appointment, please provide our office with at least 24 hours notice.  Appointments cancelled with less than 24 hours notice will be charged a fee of $25.  Appointments that are not cancelled at all (i.e. “no shows”) will be charged a fee of $25.  Multiple missed appointments prevent our providers from giving your child the proper care and can be cause for discharge in some cases.

DEDUCTIBLES, CO-PAYS, and CO-INSURANCE:  If you have an insurance that has a deductible, co-pay, or co-insurance, any amount not covered by insurance must be paid at the time of service or a $10 late fee will be applied. If you have a deductible or co-insurance, we will estimate the amount due based on the amount allowed by the insurance carrier. This helps prevent unexpected bills and late fees. If the person who is responsible for paying for the child’s healthcare expenses cannot bring the child to the appointment for any reason, the payment should be sent with the person bringing the child to the appointment. If this is not possible, please pre-pay via our patient portal.

IF YOU HAVE NO INSURANCE COVERAGE:  Payment must be made at the time of service with no exceptions.  Please let our staff know if your child has no insurance coverage.  In many cases, our staff can refer you to the appropriate programs to get your child signed up for healthcare coverage.

AFTER HOURS CARE:  One of our providers is available after hours in the event that you have an emergency.  After hours calls can be made by dialing our regular telephone number:  (716) 661-9730.  We request that this service be utilized for urgent issues only that cannot wait until morning when the office opens at 9 a.m.  Routine questions and medication refills will be handled during normal office hours.  Non-emergency calls that cannot wait until the next morning but do not require emergency services, should be made prior to 8 p.m.  If you think that your child is getting sick, it is always better to call earlier in the day when we are adequately staffed to meet your needs and give you the opportunity to schedule an appointment if needed.  The after-hours on call service is intended as a last resort before going to the emergency room.  We ask that families call only when necessary; this helps to ensure that the provider on call is available in the event that you or someone else has an emergency.

We welcome you to our practice and look forward to providing your child’s medical care.  Please call or ask our staff if you have any questions regarding the above information.