Our Billing Process
As our patient, we care about you and want to help you understand our billing process. The best action you can take as a patient to ensure that your billing is accurate and complete is to make sure that we have correct information about you. This information should include:
- Your name/address/telephone numbers
- The name/address/telephone number of your guarantor (person responsible for your bill)
- The name of your insurance company, group number, plan number, or other identifying numbers.
- Claims filing address and your insurance company's phone number.
If you are covered by insurance
You will want to determine the extent of your insurance coverage, and if you are in a managed care plan, and whether the physician of Pediatric Pulmonary and Sleep Specialists, LLP is "in network." If not, you may still be treated here, but your eligibility for insurance coverage may decrease and your personal financial responsibility may increase.
Please notify us immediately if your insurance carrier changes in order to prevent delay in processing your claims with the correct carrier and possibly even denial of your claim.
We will verify your insurance benefits with your insurance plan. We will also obtain pre-certifications or authorizations if necessary. You are responsible for obtaining referral from your Primary Care Provider (PCP) if required.
When you arrive for treatment, if you are in a managed care plan, you will be asked to pay your co-pay, co-insurance/deductible. Most plans managed care plans require that separate co-pay be collected for each physician office or clinic visit.
If you have open balances, you may also be asked to pay them prior to further treatment.
Pediatric Pulmonary and Sleep Specialists, LLP will file insurance for you for both hospital and physician visits. If you are inpatient, your hospital insurance claim will be filed upon your discharge. If you are outpatient, your outpatient hospital insurance claim will be filed approximately 14 days from your last visit. Outpatient surgery insurance claims are also filed within approximately 14 days. Insurance claims for all physician charges are filed separately, as charges are entered.
Your monthly patient statement will show amounts due. If you have a patient balance due and insurance pending, your statement will reflect both patient and insurance pending amounts. Your prompt payment of all amounts for which you are personally responsible is appreciated.
If you are not covered by Insurance
If you are not covered by insurance, one of our Financial Counselor Representatives can provide prior to treatment an estimate of the costs for your visit. This estimate will include physician charges and possible diagnostic tests. You are responsible for the full cost of your care.
If you are a self pay patient or if you have a financial obligation to Pediatric Pulmonary and Sleep Specialists, LLP after your insurance has fulfilled its financial responsibility, you will be expected to pay the balance due upon receipt of your patient statement.
Frequently Asked Questions
What should I do if my insurance changes?
Call and inform your Business Center Representative at 972-566-6996 x5. Incorrect information may cause us to miss your insurance company's filing deadline.
Why do I still have a balance if my insurance company pays 100% of Reasonable and Customary charges?
Some insurance carriers base payment on the average charge for all physicians in a given area. This practice does not take into consideration the specialized nature of Pediatric Pulmonary and Sleep Specialists, LLP and may not cover the full cost of the care you receive. You may be responsible for any balance. You are encouraged to discuss your coverage with your insurer prior to treatment.
How will my payment be applied?
Payment in full is applied to hospital/physician clinic charges. If you pay a lesser amount, your payment will be applied to the oldest open invoice. To ensure timely and accurate payment posting, please include your remittance coupon attached to your statement.