There are three different categories of patient responsibility: co-pay, deductible, and coinsurance. These usually apply per person, with annual limits for each individual as well as the family as a whole.
is the amount that you must pay up front before seeing a doctor. This is a set fee based upon the type of provider (general or specialist) and the type of visit (preventative or sick visit).
is the amount of money you must pay out-of-pocket before the insurance will begin paying toward the claims filed by your doctor’s office. The amount charged toward the deductible is the negotiated rate between your doctor and your plan, not the full amount of charges for the services provided.
is the percentage of the allowed amount, as negotiated between you and your doctor, that you are still responsible for AFTER meeting your deductible. Many other charges may be applied to your deductible, including (but not limited to) lab testing, prescriptions, procedures and screening tools. Thus you may not even know that you have met your deductible until we verify it for you. Deductibles and co-insurance amounts reset annually.
Many insurance carriers limit what is covered under the “preventative care” umbrella. They may cover your child’s annual check-up without a co-pay and without having to meet your deductible, but not cover the developmental questionnaire or hearing & vision screening.
Compass Pediatrics follows the American Academy of Pediatrics’ Bright Futures Guidelines for preventative care, and we believe strongly that these tools are not optional. It is your responsibility to notify us if you do not want a screening performed. Once performed, you will be responsible for all uncovered charges. We offer a discount on non-covered services if paid for at the time of the visit.