We understand that there are many questions when it comes to dealing with insurance companies and medical bills.
We hope this Health Insurance 101 will be helpful information, however if you have any questions do not hesitate to call our billing department at 509-332-6139.
Please bring your most current insurance card at the time of service as this information needs to be updated to provide you with the most efficient billing service. If your insurance has a co-pay then we will collect that upon check in. Palouse Pediatrics is a preferred provider for the following insurance companies:
- Blue Cross of Idaho
- Idaho & Washington Medicaid plans
- First Choice Health Network (FCHN)
- GEHA (Aetna)
- Kaiser Health Insurance
- Health Net Federal Services (HNFS)
- L&I/Crime Victims
- Medicare WA
- Regence of ID
- RR Medicare
- TriWest VAPC3
- United Health Care
Below we have listed the answers to most commonly asked questions. If you need further assistance, please contact our billing office 509-332-6139.
Q: What if my child is covered under an insurance company that is NOT listed. Can they still be seen?
A: YES! We are willing to bill any insurance for you. However we are not contracted with all of the insurance companies. This means that you may be responsible for more of your bill. We do expect $75 dollars upon check in and the remaining at the end of the visit.
Q: Do you offer a discount for patients who pay in full at time of service?
A: YES! We offer 20% discount for patients who do not have health insurance coverage and pay their bill at time of service. We do expect $75 dollars upon check in and the remaining at the end of the visit. Payments are available if you are unable to pay in full, however the discount will not be applied.
Q: Why was I charged for another office visit when my child was in for a wellness check?
A: There may be times when a child needs a service that is not considered preventative on the same day as well child visit. If a child is not well or a problem is found or needs to be addressed during the checkup, the physician may need to provide an additional office visit service (called a sick visit) to care for the child. This is a different service and is billed to your health plan in addition to the preventative services provided that day. If you have a co-payment for the office visits or coinsurance or deductible amounts that you must pay before your health plan pays for these services, our office will charge you these amounts.
Q: How do I know for sure if our doctors are covered under my insurance plan?
A: The best way to know for sure is to call your insurance and ask them directly. We are contracted with many insurance companies so there should be no problem. However, there are times we may choose not to renew our contracts with an insurance company.
Q: I received a statement from you showing that my insurance company has not been billed. Why is that?
A: Most often it is because we did not receive your current insurance information while you were in the office. If you did give us a copy of your card and you’re still receiving a bill, it may be because we failed to link your information to the visit properly. Either way, if you let us know, we can easily correct the problem.
Q: Both parents carry insurance for their child, which policy is the primary?
A: All insurance companies follow the birthday rule. The parent whose birthday falls first in the year will be considered the primary insured. We are happy to bill both your primary and secondary insurance.
Glossary of Billing and Insurance Terms:
- Applied to deductible: a portion of your bill, as defined by your insurance company, that you owe your provider
- Co-insurance: the amount you must pay after your insurance has paid its portion, according to your Benefit contract. In many health plans, patients must pay for a portion of the allowed amount. For instance, if the plan pays 70% of he allowed amount, the patient pays the remaining 30%. If your plan is a preferred provider organization or other narrow network type of product, your co-insurance costs may be lower if you use the services of an in-network provider on the plan’s preferred provider list.
- Co-Payment (co-pay): A predetermined, fixed fee that you pay at the time of service. Copayment amounts vary by service and may vary depending on which provider (in-network, out-of-network, or provider type) you use. The amounts also may vary based on the type of service you are receiving (for instance, primary care vs. specialty care).
- Deductibles: The amount a patient pays before the insurance plan pays anything. In most cases, deductibles apply per person per calendar year. With preferred provider organizations (PPOs), deductibles usually apply to all services, including lab tests, hospital stays and clinic or doctor’s office visits.
- Health maintenance organization (HMO): Health maintenance organization (HMO) (refers to health insurance)—these health insurance plans require enrolled patients to receive call their care from a specific group of providers (except for some emergency care). The plan may require your primary care doctor to make a referral before you can receive specialty care. An HMO may require you to live or work in its service area to be eligible for coverage. HMO’s often provide integrated care and focus on prevention and wellness.
- In-network: A group of doctors, hospitals and other healthcare providers preferred and contracted with your insurance company. You will receive maximum benefits if you receive care from in-network providers. Depending on your insurance plan, your benefits may be reduced or not covered at all if your receive services from providers who are not in network.