INSURANCE AND BILLING INFORMATION

Pediatric Urology Associates is committed to providing your child with the best possible care and we are pleased to discuss our professional fees with you at any time. Your understanding of our financial policies are important to our professional relationship.

Pediatric Urology Associates accepts a wide variety of insurance plans. The following list of plans we participate in includes but is not limited to:

  • Aetna/US Healthcare
  • Americhoice of NJ, Inc.
  • Amerigroup
  • Cigna
  • Consumer Health Network
  • Healthnet
  • Horizon Blue CrossBlueShield, including: HMO, PPO, POS, Direct Access, Blue Card, Federal PPO
  • Horizon NJ Health
  • Qualcare PPO
  • St.Barnabas Health Care System
  • United HealthCare
  • University Health Plans

Please contact Pediatric Urology Associates to confirm participation in your specific plan. The insurance companies often do not update their patient information brochures and websites in a timely fashion and they may be out of date.

How insurance works:

You must complete all information forms prior to seeing the physician. A copy of your insurance card(s) will be made for your file. If a co-payment is required, by law we must collect it at the time of each office visit. We will not “bill you” for the co-pay. The specialist co-payment is printed on your insurance card and is the amount we will collect.

If we participate with your insurance, we will submit our charges to your carrier. If however, we do not contract with your insurance carrier we will require payment at the time services are rendered and provide you with an itemized bill for your reimbursement.

Depending on your insurance plan, deductibles and/or a co-insurance may also apply. In some cases, patients may be billed for uncovered services or the difference between our charges and the insurer’s rate. You may also be responsible for any deductible and balance your plan indicates on their explanation of benefits (EOB). Our Billing Department will be happy to assist you with any financial issues if they should arise.

If you do not have insurance or are “self pay” payment will be expected at the time of service unless other financial arrangements have been made prior to your child’s visit.

It is important for patients to know and understand their specific insurance plan. Plans can vary widely. We recommend that you familiarize yourself with the following items before you seek health-care services:

  • Is the provider a participant in their insurance plan?
  • If yes, are they taking new patients?
  • Do I need a referral?

**If you require a referral for your visit and you do not bring it, you will be asked to reschedule your appointment. We cannot call your primary care physician.**

  • What is the co-payment?
  • What is my deductible?
  • What are my “in-network” benefits?
  • What are my “out-of-network” obligations?
  • What are my limits of coverage?
  • Is this an uncovered service?

Please be aware of the term “usual and customary." This is a term developed by the insurance carrier to reflect what they believe to be “average charges” for specific physicians in certain geographic locations. The usual and customary amount on the explanation of benefits (EOB) does not accurately reflect individual charges. Therefore, the usual and customary charges do NOT supersede our fees.

Please remember that the requirements of a patient’s insurance plan represent a contract between the patient and the patient’s insurer. Pediatric Urology Associates as the provider will make every effort to assist the patient with financial issues; however, the patient is ultimately responsible for all charges for services rendered.