INSURANCE & BILLING INFORMATION
Valencia Pediatrics accepts many PPO insurance plans.
The following is a list of the bigger insurance companies we are contracted with:
Anthem
Blue Shield
Aetna
Cigna
United Healthcare
Motion Picture Industry Health Plan
We are also contracted with many other smaller insurance companies. Please contact our insurance department at (661) 294-2229 or your insurance company to see if we are contracted with your insurance carrier. For established patients please use our Patient Portal to send a secure message to the insurance department.
INSURANCE COVERAGE
Please bring your child’s insurance card to every appointment. When you check in at the front desk, we will ask to see and verify your child’s insurance card for our records. We are only able to bill your insurance with a valid insurance card.
It is important that we have your most current insurance information. This allows for accurate claims submission so be sure to relay any changes to our reception staff. Delays in communicating these changes may result in the balance being uncollectible from the insurance company and the full responsibility for payment will fall upon the parent/patient. We accept MasterCard, Visa, Discover, American Express, cash, or checks.
CO-PAYS, DEDUCTIBLES, AND CO-INSURANCE
Valencia Pediatric Associates collects all patient co-payments, coinsurance, and deductibles at the time of service. Valencia Pediatric Associates will charge the credit/debit card that we have on file or you may choose another form of payment accepted by our office.
The best tip that we could give any of our patients is to know and become familiar with their insurance plan and its benefits. We encourage you to contact your insurance company if you have any questions about your benefits. Know what your copayment, coinsurance, or deductible are. Some plans cover nearly all office services. Others exclude well care, immunizations, labs, and other procedures. We follow the immunization guidelines established by the American Academy of Pediatrics (AAP) and the Center for Disease Control’s Advisory committee on Immunization Practices (ACIP). Nevertheless, some plans have complex regulations about when they will and will not cover vaccines and well care.
For our patients with Motion Picture Insurance, Screen Actors Guild, Director's Guild, and Writer's Guild: In order to utilize your full benefits with the Industry Health Network please call 1-800-876-8320 to obtain a onetime referral to our practice.
NEWBORNS AND INSURANCE
Most insurance companies require you to add your newborn within a 30-day period. Because we know that this process can take time, Valencia Pediatric Associates gives you up to 30 days in which to do this. Any visits during that time will be billed to your insurance company for future processing. If you’re newborn has not been added by that time we will request payment at the time of service. If you subsequently provide us with an insurance card within 30 days, we will bill the charges to your insurance company for you. If we then receive an insurance payment we will be happy to issue a refund to you or place a credit on your account.
WELL CHILD VISITS AND IMMUNIZATIONS
Insurance companies will normally process these claims as “Preventive Care”. Please note that some insurance policies do not cover this type of service or only cover it until a child reaches a certain age. Although insurance claims will be submitted by our office to your insurance company, it is the parent’s responsibility to understand and comply with their specific coverage benefits.
Sometimes during a preventive health visit the physician will diagnose and treat another problem. Services for the other problem will be billed as an additional charge. Some insurance companies will not cover two office services on the same date so payment for one of them may be denied by the insurance company or an additional co-payment may be required.
Valencia Pediatric Associates submits claims to insurance companies providing the exact services performed and the exact reason for performing them. Sometimes insurance companies may not pay all charges as they were submitted by Valencia Pediatric Associates. We cannot change the diagnosis code or a procedure code after the original claim submission (unless it is initially submitted incorrectly) so the claim or some of the services can be paid by the insurance company.
*Please note: Insurance Companies often take months before covering new procedures (i.e. vaccines and screening tools) regardless of the current recommended medical guidelines. We follow the American Academy of Pediatrics Bright Futures guidelines. Since providing quality care to our patients is our primary concern, we encourage you to contact your insurance carrier to determine coverage for such treatment. Please understand that you may be required to assume full financial responsibility for these services if they are not covered under your plan.
CREDIT CARD ON FILE POLICY
Valencia Pediatric Associates requires all patient to place a credit or debit card on file in our office. This policy is designed to help avoid all billing related fees, streamline the billing process in our office and eliminate expenses related to handling overdue accounts, and focus our time and energy on your children and their medical care.
Copays - When you come into the office, if there is a copay due, you can choose to use the card on file or another form of payment accepted by our office. If someone else brings your child in we will charge your credit card on file.
Deductibles & Coinsurance - We have reimbursement rates on file for many insurance companies and do ask that you pay your portion at the time of service. If your insurance company applies any additional patient responsibility amounts, we will charge the card on file for this amount.
Balances - We will also run the card on file for missed appointment fees, medical record fees, form fees, or other services not covered by insurance.
We understand that you may be nervous about doing this. Your information is handled by TransFirst, a secure credit card transaction company. Our employees do not have access to your card and only the last 4 digits of your card will show in our system.
FINANCIAL RESPONSIBILITY
Regardless of court designated responsibilities, we hold responsible for payment the adult who brings the child into the office for care. If parents are DIVORCED, whoever brings the child into the office is responsible for co-pays and for having a current insurance card. We must emphasize that our relationship is with you and not your insurance company. Since we have no control over what your insurance company will pay for, you will need to question and/or dispute disagreements with them personally. All charges are your responsibility from the date services are rendered. We realize that temporary financial problems may affect timely payment of your account. If such problems arise, you must contact us promptly for assistance with the management of your account. Our insurance office can be reached directly at 661-294-2229 to answer any of your questions.
Please be advised that our office charges the following fees:
Missed Well Appointment Fee Without 24 hours' Notice (New Patient/Established Patient)- $100/$75
Missed Acute Appointment Fee Without 30 minutes' Notice - $40
Medical Records Copied (CD ONLY)- $30 if mailed/ $20 office pickup
Immunization Copy (faxed, mailed, or emailed) - $5
Preschool, school, camp or sports physical forms- $15
NSF (Returned Check)- $35
Letter of Medical Necessity- $25
