Know Your Plan
This is the smartest thing you can do! Having an insurance card does not mean everything will be paid for! Be a good consumer and research your insurance plan. Find out what your plan covers and doesn’t cover for well care: visits, immunizations, lab work. Know how much your deductible, co-pay and co-insurance amounts are so you can be prepared financially.
Often times depending on your specific policy the baby may be covered under the mother’s insurance for charges incurred during the hospital stay. It is up to the family to understand how their particular plan works as our office will not have access to that information. Your new baby, however, will be seen in our office fairly shortly after birth and in office claims will be billed to the in-network insurance plan the baby will be covered under. At the first visit, our office requests a copy of the insurance card the baby is being added to. Please make sure to upload a copy at check in, or provide the information directly to our staff while you are in the office for your first visit to assist with determining eligibility
It is very important to have all paperwork needed to add the baby to your insurance policy prepared in advance of the baby’s birth. The best plan is to have the required form(s) ready to go with your human resource department only needing the few last minute basic facts (name and date of birth).
The insurance company generally allows you thirty days from the baby’s birth to add the baby to the policy; but, they will be denying claims in the meantime resulting in you having to pay attention to insurance issues during the early days of your time with your baby.
Checklist for when baby is born:
- Complete paperwork and submit to HR as soon as possible.
- Follow up with insurance within the first 30 days to determine if more information is needed.
- Respond to APL billing office in a prompt manner; they are following up regarding your child’s eligibility status and/or scheduled appointments.
- Call our office for any insurance or eligibility questions at (847)398-0400.
What happens if my baby is over 30 days and is not active on the insurance?
- If your baby is approaching 30 days without insurance showing as active and eligible, our billing specialist will reach out to you to advise you of your options.
- Visits for babies with ineligible insurance will need to be paid for at time of service, if the insurance is retroactive to the date of birth, APL will refund payment directly back onto the card used.
- If you would rather reschedule the appointment out a few days until insurance is active, call the front desk at (847)398-0400 and one of our friendly receptionists will be happy to assist you. If you need to reschedule your appointment, this should be done at least 24 hours prior to your child’s appointment to avoid a same day cancellation fee.
Deductibles, Co-Pays, Co-Insurance, and Non-Covered Services
Each insurance policy has its particular parameters but most coverage will involve at least one, if not all four of these patient responsibilities. Each of these are separate items and having responsibility for one does not eliminate responsibility for others.
A deductible is a set dollar amount that you must pay before your insurance company assumes responsibility. The deductible amount is due promptly when you receive a statement from us.
A co-pay is an amount you must pay at each visit as specified by your insurance carrier and may be required for all visits – well or sick. Co-pays are due at time of service.
A co-insurance is a percentage of the charge your insurance company has determined to be your responsibility after you’ve met your deductible. The actual dollar amount is based on the amount allowed by your insurance carrier after any contractual adjustments. The co-insurance amount is due when you receive a statement from us.
Not all services may be covered by your insurance. We will be notified by your insurance company once they have processed your claim and these charges will be turned over to your responsibility.
Payment for non-covered services is considered patient responsibility and is due when you receive a statement from us.
Arlington Pediatrics, Ltd. does not accept self-pay patients. If you are a current patient and have a lapse of insurance or a gap in insurance coverage, please contact our billing office as soon as possible prior to upcoming appointments.
Accounts that are considered “not in good standing” will need to resolve the current account balances (individual or family balances) prior to scheduling wellness visits. The office defines an account as “not in good standing” by two or more statements being mailed with no resolution, or balances older than 60 days for any member of the family. Please note that for family accounts with balances greater than 60 days old, future appointments may be cancelled until billing issues are resolved.
If your family has questions regarding payment, are having challenges with insurance eligibility, or is experiencing economic hardship, please contact the billing office specifically, so payment options can be discussed.
We’re Here To Help
If you have further questions about these insurance and payment details, please contact our office by calling (847) 398-0400 or our billing specialist at (847) 370-4421.
Arlington Pediatrics, Ltd. is located at:
3325 N. Arlington Heights Road, Suite 100A
Arlington Heights, Illinois 60004