Billing & Insurance
Our billing team does their best to make insurance claims as painless as possible.
Health Insurance
We bill participating insurance companies for you, including secondary insurance.
Insurance Cards
Please bring your child’s current insurance card with you to each visit. This helps ensure that the proper information is processed, and the appropriate insurance is billed for that day’s visit.
Co-pays & Deductibles
Depending on your insurance policy, a copayment and/or deductible may be required at the time of service. Payment may be made in cash, in-state personal check, Visa, Mastercard, Discover, American Express, or Apple Pay.
A service fee of $10 will be charged if we do not receive your co-payment within 5 days of the visit. If we have not received payment from your insurance company within 45 days of the date of service, you will be expected to pay the balance in full.
Medication cost is a challenging reality for many, and medication coverage often changes. If a recommended treatment is too expensive and/or not covered, call our office and we can check whether there are suitable treatment alternatives.
Plan Changes
If your insurance plan or carrier changes, it is your responsibility to notify our office. If our office is not notified of insurance changes within 30 days of filing a claim, the account holder will be held responsible for the charge.
Denied Claims
Claims denied by insurance companies will be billed to the responsible party.
Accepted Insurance Plans
- To make our practice accessible to all families in the community, we participate in a variety of insurance plans, including VT Medicaid.
- Aetna, First Health Networks
- Blue Cross/Blue Shield
- CBA Blue
- Cigna
- MVP Health Care
- North American Preferred
- Tricare
- Vermont Medicaid
- United Healthcare
There are a few insurance companies with whom we do not participate. For these companies, full payment from you is expected at the time of service. Your time of service receipt includes all information necessary for submitting claims to your insurance company.
Tips for New Patients
To ensure you maximize the benefits provided by your insurance company, we suggest you take the following steps:
- Call the member services number on your health insurance card. Tell the insurance company the name of your child’s Essex Pediatrics doctor. If you have just had a baby, call your insurance company immediately to add your infant to your policy.
- Ask the insurance company or your employer human resource department to review the terms of your insurance contract. Some insurance plans have large deductibles and little or no well child coverage. Ask your insurance carrier the following questions:
- Do I have a deductible?
- Is well child care covered by my insurance?
- Are immunizations covered by my insurance?
- How many checkups are covered per year?
- What is my copay and is it required for all visits?
- What is your policy coverage for Emergency Room care?
- Follow up with your insurance company 2–3 weeks after you sign your contract or enroll a new child to your plan to verify they have correctly recorded your child’s new doctor.
Secure & Convenient Online Payments
Essex Pediatrics works with industry-leader Payment Pros to enable our patients to safely and securely pay their bill online through our website or through your patient portal.
In addition to paying your Essex Pediatrics statements online, you have the option of registering for an account. This provides:
- Convenience & Security
Securely save your payment information on file for future use - Keep track of payments
View your payment history and print receipts at any time
Financial Policies
Essex Pediatrics is dedicated to providing you with the best possible care and service. Your clear understanding of your financial responsibilities as an essential element of your children’s care.
Unless other arrangements have been made in advance by either you or your health coverage provider, full payment is due at the time of service.
We understand there are times when extenuating circumstances cause financial hardship. If this occurs, please contact our billing office to discuss a payment plan.
- Essex Pediatrics accepts cash, in-state personal checks, Visa, Mastercard, Discover, American Express, and Apple Pay.
- There is a service charge of $20 for returned checks.
- There is a $7 fee for each bill sent after the initial statement.
- All fees from our collection agency for overdue account balances will be your responsibility.
- Any account sent to our collection agency for lack of payment may be dismissed from our practice.
- Inquiries regarding charges for procedures are the responsibility of the patient / parent.
- The expense for services provided is the responsibility of the legal guardian escorting the child, regardless of existing legal arrangements. Except in limited circumstances, such as in the case of an emancipated minor, all legal guardians are financially responsible for their children’s care.
- Refunds: Upon written request within 30 days, overpayments will be refunded to the responsible party.
*Insurance Billing and Coding Update*
Over time, some insurances have changed how they are covering visits and/or applying parts of some visits to deductibles and patient cost sharing agreements.
Preventive care visits can go by different names, such as Check-Up, Annual Physicals, Wellness Exams, Well Child Exam, etc. These are “healthy care visits”. These appointments scheduled based on national guidelines, and are made to discuss routine preventative care, lifestyle management, update your immunizations and screening tests, and generally address issues to keep you healthy. Most insurances cover these visits in full without co-pay or deductibles applied. Unfortunately, there are increasing circumstances where insurances are not covering certain procedures, treatments, topics, or concerns under the umbrella of a “well child visit”. Instead, insurance companies increasingly categorize concerns not covered under a well visit as “Evaluation and Management” visits, meaning the concern could exist as a separate stand alone appointment..
In part to improve access and to decrease the number of visits families have to make, we always try to address all of your concerns during any visit. There may be office visits, including annual physicals, where the scheduled time is not sufficient, and a follow-up visit may need to be scheduled. However, when time allows, we will try to address these additional concerns during the active visit.
During a preventative care visit, if we address additional problems, topics, or concerns, or we address any ongoing chronic medical conditions, we must also document and claim these problems to your insurance company. Depending on your insurance, these additional problems will often be subject to co-pays and deductibles, so you may receive an additional bill for this service.
What most insurances consider part of the Preventative of Routine checkup:
- General physical exam based on age
- Growth and vital signs
- Screening tests based on age and/or risk factors
- Advice and information about staying healthy and established healthy habits
- Identifying risk factors for certain conditions
- Immunizations
What most insurances consider “Evaluation and Management” visits:
- New illness or injury
- Chronic/recurrent symptoms
- Targeted diagnostic testing
- Developmental, Behavioral, and/or Social-Emotional concerns
- Management of chronic conditions, particularly ones that require ongoing medication management and/or coordination with resources, including Asthma, Depression, Anxiety, ADHD, Autism, Diabetes, etc.
- Care Coordination, referral coordination
- Chart Review, including visits to specialists, consults, interpretation of labs, etc.
As always, we want to hear from you if there are any ongoing questions or concerns. Please call the office at 802-879-6556 and we will assist you.