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 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 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.
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 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.
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.
We currently accept:
For more details or information regarding insurance coverage, please contact our offices.