Westwood-Mansfield Pediatrics Billing & Payment

We are pleased that you have chosen our practice to manage your child’s health care needs. Personal and compassionate care is the first priority amongst our staff. To keep the cost of your healthcare to a minimum, Westwood-Mansfield Pediatrics requests that you please review the guidelines below.

Insurance and Billing

We accept most insurance plans including:

• Aetna
• Blue Cross/Blue Shield
• Cigna
• Fallon Community Health Plan
• First Health/CCN Network (HCVM)
• Great-West Health Care
• Harvard Pilgrim Health Care
• Mass Health
• Private Healthcare Systems (PHCS)
• Tri-Care
• Tufts Health Plan
• Unicare
• United Healthcare

Please be sure to bring your child’s insurance card with you each time you visit the office.

Please arrive prepared to make payment in full at the time of service.

• Payment for services provided in the physician’s office is expected at the conclusion of your visit.
• For your convenience, we accept cash, check and credit card payments.
• For balances after insurance payment, family statements are mailed monthly. Payment in full is expected upon receipt of the statement. For our patients with financial difficulty, we do offer monthly payment arrangements. Please contact our Billing department to arrange a mutually agreeable payment plan.

Patients With Health Insurance

Insurance is an arrangement between an individual and an insurance company (and sometimes an employer) to help pay the cost of medical care. Each plan has individual limitations as to what it specifically covers. Due to variations in deductible and co-payment requirements, insurance rarely covers the entire bill. Because of the many different insurance plans and coverage types available, it is impossible for Westwood-Mansfield Pediatrics to be familiar with each insurance arrangement. As a courtesy, Westwood-Mansfield Pediatrics will present a bill for services rendered to your child’s health insurance carrier, but it is ultimately the parent/guardian’s responsibility to ensure all services are paid in full.

It is the responsibility of the parent/guardian to know and understand the details of their child’s health insurance coverage. Not all services may be covered by your child’s health insurance plan. Therefore, the obligation to understand what services are covered remains the responsibility of the parent/guardian.

Co-payments and any prior patient balance will be collected at the time of service.

Due to filing limitations with many insurance carriers, it is the parent/guardians responsibility to inform Westwood-Mansfield Pediatrics of their child’s health insurance coverage at the time of each visit. Parents/Guardians who do not present their child’s insurance card at the time of the visit may be required to pay for the service. You may be required to sign a non-covered services waiver so that we can bill you directly.

Services Rendered

Although your child may be scheduled for a particular type of visit, the provider of service may deem it in the best interest of your child to address other matters of concern which were not originally planned at the time the appointment was scheduled. This may result in another charge billed to your insurance carrier and possibly an insurance/patient cost sharing (deductibles, co-payments and/or co-insurance). This is a widely acceptable industry standard of care. If you have any questions regarding services rendered, please feel free to contact our office.

HMO Insurance Plans

Primary care physician selection

Your insurance plan may require your notification of the Primary Care Physician (PCP) you have selected to manage your child’s healthcare. If this notification is not on file with your insurance plan, services may be denied leaving the entire balance your responsibility. Please notify your insurance carrier promptly of the PCP you have selected for your child.

Services requiring referral/pre-certification or authorization

Your insurance may not pay for certain visit or services which have not been referred by your Primary Care Physician (PCP). You are, therefore, responsible to confirm that the Westwood-Mansfield Pediatrics Referral Coordinator receives the appropriate referral, pre-certification or authorization details to initiate a valid referral. Please check with our referral coordinator to confirm a referral has been processed prior to receiving specialists services. If we do not receive this information prior to the specialist appointment, you may be financially liable for these services.

Westwood-Mansfield Pediatrics may charge a “No Show” fee for missed appointments or for appointments canceled without 24 hours notice. We regret that we have determined it necessary to institute this policy. However, by canceling your appointment 24 hours or more prior to the appointment, you will avoid this fee.

As a courtesy, the practice makes every effort to make appointment reminder calls for most non-urgent appointments, however, should this courtesy not occur and the appointment is missed, the charge is still applied and payment expected.

Patient Balances

All patient balances must be paid in full within 30 days of receiving a bill from Westwood-Mansfield Pediatrics. If you have not paid your balance in full within ninety (90) days after the date of the original bill, your account will be reviewed for collection agency placement. You will be held responsible for your entire balance.

Refunds

Patient/guarantor payments resulting in an overpayment on the account will be refunded upon scheduled review of the account or upon parent/guardian request. Refunds under $5.00 will be processed by request only.

Returned Checks

Any guarantor payments in the form of checks that are returned from the bank as unpaid will be charged back to the guarantor. In addition, a $20.00 bank fee will be charged to your account which will remain the responsibility of the guarantor.