Insurance Basics

Insurance Basics

Understanding your insurance policy is vital to coordinating your child’s health care. Here are a few tips to ensure the correct handling of your insurance claims:

 

Your insurance policy is a contract between you and the insurance company.

Our reimbursement for services provided is also based on a contract between Compass Pediatrics and your insurance company. We are obligated to report all services provided and to bill for them in accordance with our fee schedules. Much as it would be a contract violation for you to refuse paying your insurance premium, it is also a contract violation to not charge or to undercharge for services we provide.

 

Charges for services provided may vary depending on many factors.

Check-ups are billed based on age, but other visits are billed based on a complicated system of time, complexity, number of diagnoses, and medical decision making. Therefore charges may not be the same for each visit. In addition, you may be billed for services including (but not limited to) laboratory testing, screening tools, vaccines, procedures, counseling, urgent visits and after-hours visits.

 

Carry your insurance card with you at all times.

It should have your name or the names of your covered dependents, the policy and group numbers, the claims mailing address and phone number, and the co-pay information. Your doctor may not be able to see you without verification of insurance benefits, or you may have to pay out-of-pocket for the visit.

 

Understand your insurance benefits.

Your insurance plan decides which benefits are covered in full, which apply to your annual deductible, and whether or not they will allow the benefit and pay for the service. Your doctor’s office does not make this decision. If your policy does not cover the service, you will be responsible for the full amount.

 

Understand which specialists and laboratories are in-network with your plan.

The best way to verify that the specialist, doctor, or lab is in-network is by calling your insurance company directly. You are not prohibited from seeing a doctor who is out-of-network, but you may be required to pay the full amount of charges. We are happy to see your child even if we are NOT in-network with your insurance company.

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