Medical offices that take insurance get paid by “coding” what they do. These codes are designated by the Center for Medicaid and Medicare Services (CMS). A new code – G2211 – has been created for primary care providers to indicate that they are following patients longitudinally and are committed to caring for the “whole patient” over time. Unlike urgent cares and emergency rooms, Center City … [Read more...] about What is this “Continuity of Care” Fee on My Bill?

We often liken insurance statements to grocery store receipts – each service, procedure, lab and screening is itemized and billed separately. Sometimes, it is difficult to understand which portion is being reimbursed by your carrier and which is your responsibility. Our Billing Department fields a lot of questions about statements, often specific to confusion around well-visit appointments. It … [Read more...] about Why am I responsible for a co-pay after a “well-visit”?

If your child’s insurance plan requires a Primary Care Physician (PCP) to be chosen, we ask you to ensure you have Center City Pediatrics selected as their PCP before your first appointment. If we are not chosen as your child’s PCP, your insurance will deny, and you will receive a bill in the mail from us. Please contact your insurance and advise them you would like to make Center City … [Read more...] about Why did I receive a bill for PCP?

Coordination of Benefits (COB) must be completed by the subscriber of the insurance. Please contact your insurance company by calling the phone number on the back of the insurance card and let the representative know that you would like to coordinate benefits for your child. This just means that the insurance is questioning whether the child/family have other active insurance. They would have … [Read more...] about What does COB mean?

Typically, insurances will cover the number of visits recommended by the American Academy of Pediatrics (AAP). The first week visit (3 to 5 days old) 1 month old 2 months old 4 months old 6 months old 9 months old 12 months old 15 months old 18 months old 2 years old (24 months) 2 ½ years old (30 months) 3 years old 4 years and older- once a year (365 days since last … [Read more...] about How many well visits will my insurance cover in a year?

If you are asked to return for a visit by a provider, usually regarding a weight check due to a feeding difficulty, failure to thrive, low birth weight etc., the visit will be considered a sick visit {there are 2 types of visits 1) well 2) sick}. If your “sick visits” are not covered at 100% by your insurance, you will be responsible for any copay, deductible, or co-insurance due after the … [Read more...] about Why did I receive a bill for a weight check?