BROOKLYN OFFICE

Telephone: 718.833.2300
Address: 7715 4th Avenue, Brooklyn NY

STATEN ISLAND OFFICE

Telephone: 718.982.6800
Address: 1779 Richmond Avenue, Staten Island NY

Insurance & Billing

Billing & Payment

GPM Pediatrics, PC wants to help you understand your medical bill and will always provide clear information regarding the billing details of the provided healthcare services. In order to assist you, we have defined common billing terms below.

Co-payments

Co-payments are a contractual agreement between the policyholder and their insurance company. The co-payment is part of the payment, which is issued to your physicians. This payment is made at the time of your child’s appointment. Well visits are excluded from Co-payments unless otherwise instructed by your insurance carrier.

Deductibles

Deductibles are an out-of-pocket expense. The amount of the deductible is based on the policyholders’ contract with their employer and their insurance carrier. There are in-network deductibles and out-of-network deductibles.

Non-Covered Procedures

The policyholder receives the explanation of benefits (EOBs) in the mail from their insurance carrier; they explain what procedures were performed on that date of service. These are procedures that your insurance company will not cover and pay. The EOBs will determine what the policyholder is responsible for, if the insurance does not cover procedures. Self-pay patients are responsible for all charges and should be paid at time of service. If this is not possible, you must see the billing department to discuss a financial agreement.

Co-insurance

Co-insurance is also an out-of-pocket expense. Co-insurance is based on the member’s contract with their insurance carrier. Some insurance carriers pay at a percentage rate of 80/20 while others may pay at a percentage rate of 70/30; the rates vary. Depending on the percentage rate, your insurance will pay that percent, leaving the balance to the member. If the secondary insurance does not cover, then the policyholder would be responsible.

We expect payment of your co-pay at the time of service. For your convenience we accept cash, check, and the following credit cards:
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Monthly payment arrangements can be set up, please contact Billing at 718.982.6800 or via email at billing@gpmpediatrics.com. You can also choose to pay your bill online.

Important Information

  •  Most Union Plans are accepted
  • We do not participate with Medicaid directly.
  • We DO NOT accept EmblemHealth Select Care Network Plans. This means NO GHI or HIP that say SelectCare on them.
  • PANELS CLOSED: Patients currently on this plan will continue to be seen by our practice; however no additional patients can go onto these insurances, please contact our office for more information.
  • We do our best to stay on top of each patient’s insurance policy; however, it is your responsibility to notify us of any changes in your insurance to ensure that the claim is sent to the correct insurance plan and that you are not held responsible for the charges.
  • On occasion, we may ask you to become involved in assisting us with contacting your insurance company to resolve a claim.  Also, it is your responsibility to understand the specific coverage benefits and limitations your plan provides.
  • Please note that if any members of your family are admitted to the hospital, please follow your insurance company requirements to reduce your risk of payment problems.

Important Note for PARENTS: Please note that it is extremely important you add your newborn to your insurance policy once your baby is born. Most insurance plans have a 30-day grace period. Once the grace period has expired and the baby is not added on the insurance policy, the parents will be responsible for charges endured. Please remember to bring your insurance card, co-pay, and patient forms to your first visit. 

Participating Insurance Plans

We currently accept:

  • 1199 National Benefit Fund
  • Aetna – HMO & PPO
  • Cigna
  • Emblem Health/GHI
  • Emblem Health/HIP
  • Empire BC/BS – HMO & PPO
  • Empire BC/BS Health Plus Medicaid Funded & Child Health Plus (PANELS CLOSED*)
  • First Health
  • Horizon of NJ PPO (Blue card ONLY)
  • Humana/Choicecare Network
  • Magnacare
  • Multiplan
  • NY Government Plan (United HC Empire Plan)
  • Oxford Liberty & Freedom (Excluding Metroplan)
  • Tricare
  • United Healthcare
  • US Family Healthplan
  • Most Union Plans Accepted

For more details or information regarding insurance coverage, please contact our offices.