Insurance Policies
Dayton Pediatrics, PC is a participating provider for Tennessee Bureau of Tenncare, Blue Cross Blue Shield of Tennessee, United Healthcare, Cigna and many, many other insurance programs. We are pleased to provide this service to our patients; however it is impossible for us to keep track of each plan's individual requirements. Please make sure you understand the benefits and requirements of your plan and be aware of any changes that may occur over time. Plans differ depending on the type of contract your employer may have negotiated. Most plans have stipulations regarding how often, where, and by whom medical services may be rendered. For example, some plans do not cover the hearing and vision testing we provide. Some plans have wellness maximums based on a dollar amount or on a set number of visits within a certain time frame. A majority of plans require wellness visits to be at least one full calendar year from the last wellness exam in order to be covered; and some wellness visits may not be covered over a certain age. Your insurance is a contract between you and your insurance company; therefore, it is very important that you take an active role in understanding your benefits.
Newborns
It is important that you add your newborn to your insurance policy within the first 30 days of life. This will prevent any lapse in coverage. Contact the Bureau of Tenncare or your human resources department for the proper paperwork and their guidelines.
Frequently Asked Questions
Q: What is COB?
A: COB stands for Coordination of Benefits. Most insurance companies send out a yearly questionnaire inquiring whether you have other insurance coverage. Claims are typically pended once this information has been requested from the member and will not be paid until the policy gets updated. It is the policyholder's responsibility to update this information to ensure proper claims processing. The policyholder will be held responsible for charges until they update this information with the insurance company.
Q: My child has double coverage. How do I know which one is primary?
A: When there is double coverage, the "birthday rule" applies. The parent whose birthday falls earlier in the year is named as the primary insurance and the other is secondary.
Q: I have received a bill from your office. Did you file my insurance?
A: If we participate with your insurance company, we will file your insurance for each visit. Claims are submitted daily.
You will not receive a statement unless we have received correspondence from your insurance company stating that a balance is due from you.
Q: My bill states a deductible and/or coinsurance applied. What does that mean?
A: A deductible is the amount of out of pocket expenses you must pay the doctor or hospital before your policy will pay any benefits. Co-insurance is the percentage that the insurance company will pay from the total claim. It is the ratio of splitting the bill between the insurance company and you. Because each plan differs, you will need to check with your insurance company or your schedule of benefits to find out what services apply to your deductible or coinsurance.
List of Insurance Carriers
Dayton Pediatrics is a participating provider with the following insurance carriers:
BlueCross BlueShield of Tennessee (www.bcbst.com)
UnitedHealthcare (www.uhc.com)
Cigna (www.cigna.com)
Aetna (www.aetna.com)
My TRICARE (www.mytricare.com)
PLEASE NOTE: The above list is subject to change at any time. Dayton Pediatrics' participation with your insurance carrier does not guarantee payment of services. YOU ARE UNTIMATELY RESPONSIBLE FOR ALL CHARGES.
Financial Policy
The following is a statement of our Financial Policy which we will require you to read and sign prior to treatment.
FINANCIAL ARRANGEMENTS: I authorize, direct and assign benefits payable by given insurers to pay directly to Dayton Pediatrics any and all payable amounts up to the amount of my indebtedness with Dayton Pediatrics. I understand my insurance will be filed for amounts due. I understand that I am ultimately responsible for payment of my bill in full regardless of insurance status. I acknowledge that insurance claims are filed as a courtesy to me and any payment issues will be my responsibility. I understand and agree that I will promptly pay for services rendered to me by Dayton Pediatrics. I understand that should I fail to comply with payment agreements/obligations, my account may be referred for collections and I agree to pay all collection cost including reasonable attorneys fees.
I ALSO UNDERSTAND THAT CO PAYMENTS SET FORTH BY MY INSURANCE ARE DUE AND PAYABLE AT THE TIME OF SERVICE. I AGREE TO PAY THOSE CO PAYMENTS AS REQUIRED.
Due to frequent changes in health insurance coverage, we require that you provide proof of insurance coverage at each visit. If you do not have insurance, are unable to provide proof of insurance coverage, or are on a plan in which we do not participate, full payment is required at the time of your visit.
For your convenience we accept cash, check, Visa/Master Card (including debit cards), American Express and Discover.
Financial arrangements for large balances can be made through our payment program. Failure to resolve any past due accounts, including returned checks will result in referral to a collection agency.
In bringing up children, spend on them half as much money and
twice as much time.
~Author Unknown
