Insurance

In order to provide flexibility for our families, we accept most commercial insurances and participate in many managed-care plans.
 

Amherst Pediatrics currently bills to many different insurance companies with many different plans. The options and coverages vary so considerably and are so numerous that we may not know the intricate details of each policy.

We urge you to become familiar with your own insurance so that you understand its rules, coverages, and limitations. All insurance companies have time limits for billing claims and HMO plans have especially strict and short filing limits. If the information that we use for billing comes directly from your insurance company via your child's insurance card, we have more success in meeting the filing limits and avoid having to transfer claims directly to you for payment.

A few tips that we believe will ensure that your insurance company pays the claims submitted by us on your behalf

  • When your baby is first born, call your insurance company as soon as possible to:                  
    • Add your new baby to your policy effective the date the baby was born
    • Designate an Amherst Pediatrics Physician as your baby’s PCP (primary care provider)               effective as of the baby’s birth date
    • Write down the name of the representative that you speak with and note the date the                 conversation took place
    •  If the representative gives you an ID number and /or a suffix write down the information           carefully and stress that you want a card sent as soon as possible
  • As soon as you receive your child’s card and have verified that the information is correct, make a copy of both sides, put your child’s name and date of birth on the copy and send it to our billing office OR If your child has a visit in the near future, bring it with you and we will make a copy for our records.
  • If your insurance changes, please notify us as soon as possible with a copy of your new insurance card and the effective date of the new policy. Please remember to designate an Amherst Pediatrics Provider as the PCP for your child with the new insurance company
  • Most insurance companies will send an EOB (explanation of benefits) form to you about claims they are or are not paying. If you do not understand it or have any questions, call your insurance company as soon as possible.
  • In rare situations, usually in the case of newer vaccines, a managed care plan may not pay or only partially pay for a submission. In this situation we will bill you directly for the difference between the insurance allotment and our wholesale cost to purchase the medication.